Reversible wall motion abnormality on adenosine stress/rest thallium-201 gated myocardial SPECT is an independent predictor of coronary artery disease

International Nuclear Information System (INIS)

Park, Eun Kyung; Lee, Won Woo; So, Young; Eo, Jae Seon; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun; Kim, Cheol Ho; Lee, Sang Woo

2004-01-01

As early as 10 minutes after adenosine stress, immediate post-stress wall motion (ipsWM) can be evaluated on adenosine stress/rest TI-201 gated SPECT (gSPECT). To widen application of TI-201 in gated SPECT, we investigated image quality, LV parameters (EF, EDV, and ESV) reproducibility, and diagnostic competency of gSPECT regarding ipsWM evaluation Myocardial perfusion and wall motion were evaluated by 5-point scoring system in 20-segment model. Image quality was assessed using weighted Kappa (Kw) for inter-and intra-observer agreements of wall motion scores (n=49). Reproducibility was examined through repeated acquisition (n=31). Diagnostic competency was evaluated versus coronary angiography (CAG) and multivariate logistic regression analysis was performed to identify significant predictors of coronary artery disease (CAD) among stress abnormal perfusion (SSSp), stress abnormal wall motion (SSSwm), and reversible abnormal wall motion (SDSwm) (n=60). Kw for ipsWM was significantly better than that for rest regarding inter- (0.717 vs 0.489) and intra-observer agreements (0.792 vs 0.688) (p<0.05). 2SD for ipsWM was smaller than that for rest at EF (8.6% vs 10.7%) and ESV (6.0ml vs 8.4ml). Sensitivities of SSSp, SSSwm, and SDSwm were 63.3% (19/30), 63.3% (19/30), and 43.3% (13/30) and specificities 83.3% (25/30), 83.3% (25/30), and 86.7% (26/30), respectively. By multivariate analysis, SSSp (p=0.013) and SDSwm (p=0.039) remained significant predictors. Additionally, SSSwm or SDSwm could find undetected CAD in 54.5% (6/11) of patients with normal perfusion. TI-201 can be successfully applied to gated SPECT for ipsWM evaluation. Moreover, reversible wall motion abnormality on gSPECT is an independent predictor of significant CAD

The clinical significance of abnormal 99Tcm-MIBI myocardial perfusion tomography in patients with hypertension

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Yang Yongzhen; Li Zhaoping; Liu Yimin; Zhang Weifang; Zhang Yanyan; Zhang Songlin; Wang Xin; Mao Yuan

2000-01-01

Objective: To evaluate the clinical significance of abnormal myocardial perfusion tomography in the hypertensive patients with normal coronary angiography. Methods: Qualitative diagnosis, the average counts ratio of lateral to septal segments (L/S) and the ratio of stress L/S to rest L/S from stress and rest 99 Tc m -sestamibi myocardial perfusion tomography (MPT), and every clinical characteristic and the results from other examinations were compared between hypertensive patients (HP) and normotensive controls (NC). Every risk factor leading to coronary artery disease and related indexes in patients with positive MPT were compared with the results of patients with negative MPT. Results: 1) The positive rate of MPT in HP was obviously higher than that of NC,which was 61.9% vs 9.1%, respectively. Most focuses of MPT were reversible defects (RD), a few of them accompanied by reverse reversible defects (RRD). There were many more angina pectoris and heart arrhythmia attacks in HP than in NC. 2) The ratio of stress L/S to rest L/S of HP was lower than that of NC (P<0.05). 3) The ratio of stress L/S to rest L/S of the patients with positive MPT in HP significantly decreased compared with that of the patients with negative MPT (P<0.01). There were more patients being addicted to smoking and drinking in those with a positive than in those with a negative MPT (53.8% versus 12.5%, P<0.05). 4) The abnormal defects of MPT in HP were almost seen in any segment of left ventricle and most of the patients had no left ventricular hypertrophy, but did smoke and drink. Conclusions: 1)Abnormal MPT exist in the HP with normal coronary angiography and not necessarily with left ventricular hypertrophy. 2)The long-term addiction of smoking and drinking was one of the risk factors leading to arouse myocardial ischemia in HP

Assessment of ischemic heart disease by dipyridamole stress electrocardiographic gated myocardial single photon emission computed tomography with technetium-99m tetrofosmin

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Kanna, Masahiko; Mitani, Isao; Nakamaru, Masashi; Shibuya, Ken; Takeda, Kazuyoshi; Asahina, Shigeru; Kitamura, Yutaka; Higuma, Kikuhiko; Ishii, Masao

1998-01-01

Simultaneous assessment of stress perfusion and rest function is possible with gated single photon emission computed tomography (SPECT) using stress injected technetium-99m ( 99m Tc) tetrofosmin (TF). The feasibility of dipyridamole stress electrocardiographic gated myocardial SPECT (GSPECT) with TF was examined as an alternative to conventional stress/rest imaging. Fifty-one patients underwent stress GSPECT. 740 MBq of TF was administered 3 min after dipyridamole infusion. GSPECT acquisition was performed one hour after the injection. Additional rest SPECT was performed on another day only in patients with abnormal perfusion on stress images. Perfusion and thickening were analyzed visually on 17 segments of the left ventricle. Percentage of wall thickening (%WT) was also calculated in 17 segments of the polar map. Thirty-two of 51 patients (63%) had normal stress perfusion and normal rest thickening. Nineteen of 51 patients (37%) had abnormal perfusion on stress images. Among 157 abnormal perfusion segments of the 19 patients, 139 segments (89%) had thickening and the rest (11%) had no thickening. %WT was higher in the reversible segments with or without thickening. There was better agreement for the identification of normal segments and the presence of reversibility between stress GSPECT and the conventional stress/rest study in patients without previous myocardial infarction than in those with previous myocardial infarction (89% vs 79%). These results suggest that stress GSPECT may substitute for conventional stress/rest perfusion study in patients without previous myocardial infarction, allowing shorter examination time and lower cost. However, stress GSPECT does not replace the need for rest perfusion study in patients with previous myocardial infarction, because of underestimation of viability, but %WT may eliminate this underestimation. (author)

Evaluation of initial uptake and redistribution on stress thallium-201 myocardial perfusion images in patients with myocardial infarction

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Watanabe, Yoshihiko; Tonooka, Ichiroh; Kanaya, Tohru; Tsuiki, Kai; Yasui, Shouji.

1984-01-01

Stress thallium-201 myocardial perfusion imaging was performed on 29 patients with previous myocardial infarction and 29 patients with angina pectoris at exercise to evaluate thallium-201 kinetics in ischemic heart disease. Four views of thallium-201 images (right anterior oblique, antero-posterior, left anterior oblique and left lateral views) were obtained at 5 min after treadmill exercise with administration of 2 mCi of thallium-201 chloride (initial image) and at 3 hours later (delayed image). Myocardial images were divided into 6 segments (anterior, lateral, inferior, posterior, apical and septal segments) and initial uptake (IU) and redistribution index (RDI, the ratio of the maximal washout rate to a washout rate in each segment) were calculated in order to assess the relations of thallium-201 kinetics to wall motion abnormality and coronary artery stenosis. In myocardial infarction, IU and RDI were decreased in proportion to the severity of wall motion abnormality and coronary artery stenosis. Contrarily, in angina pectoris, IU was decreased but RDI was increased proportionally to the severity of coronary arterial stenosis. In conclusion, IU and redistribution of thallium-201 were affected essentially by both the grade of coronary arterial stenosis and the amount of residual viable heart muscle in patients with ischemic myocardial disease. (author)

Evaluation of myocardial abnormalities in patients with collagen diseases by thallium-201 myocardial scintigram

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Yamano, Shigeru (Nara Medical Univ., Kashihara (Japan))

1992-08-01

This study was performed to evaluate myocardial lesions in patients with collagen diseases by rest and exercise thallium-201 myocardial scintigraphies. A total of 76 patients without ischemic ECG changes, consisting of 27 cases of systemic lupus erythematosus (SLE), 17 cases of polymyositis or dermatomyositis (PM[center dot]DM), 11 cases of progressive systemic sclerosis (PSS), and 21 cases of Sjoegren's syndrome (SjS), were enrolled in this study. Reversible exercise-induced defects suggesting myocardial ischemia were noted in 12 cases of SLE, 5 cases of PM[center dot]DM, 3 cases of PSS, and 3 cases of SjS. Of the 23 patients who had exercise-induced defects, 9 patients showed normal coronary angiograms by cardiac catheterization. Fixed hypoperfusion areas were observed in 5 cases of SLE, 6 cases of PM[center dot]DM, 4 cases of PSS and 3 cases of SjS. Rest thallium-201 myocardial scintigraphy disclosed hypoperfusion areas, which were not induced by exercise, in 1 case of SLE, 4 cases of PM[center dot]DM, 1 case of PSS and 5 cases of SjS. Endomyocardial biopsy was performed on 20 patients. Myocardial lesions in PM[center dot]DM and PSS were more severe and wide spread than in SLE. Ejection fraction and fractional shortening evaluated by echocardiography had no significant differences between each disease group and the healthy control group. These findings suggest that patients with collagen diseases show the presence of abnormalities of coronary circulation at the level of the intramyocardial vasculature in the stage before impairment of cardiac function, myocardial fibrosis and functional abnormalities of the cell membrane level that were not dependent on myocardial ischemia. (author).

Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events

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Furuhashi, Tatsuhiko; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Nakazato, Ryo; Fukuda, Hiroshi; Sugi, Kaoru; Moroi, Masao

2011-01-01

Stress myocardial perfusion imaging (MPI) is an established means of predicting cardiovascular events and is suitable in chronic kidney disease (CKD) patients. We aimed to evaluate the prognostic value of CKD parameters and an abnormal stress MPI for cardiovascular events. A total of 495 patients with suspected coronary artery disease (CAD) or history of CAD including 130 CKD patients not undergoing hemodialysis, underwent stress MPI (313 males, mean age 70 years) and were followed up for 14 months (mean period). CKD was defined as an estimated GFR of 2 and/or persistent proteinuria. Cardiovascular events were defined as sudden cardiac death, acute coronary syndrome and congestive heart failure requiring hospitalization. Cardiovascular events occurred in 41 (8.3%) patients. Multivariate Cox regression analysis indicated that CKD [hazard ratio (HR) =3.76, p<0.001] and a stress MPI summed difference score (SDS) of ≥2 (HR=3.78, p<0.001) were independent predictors of cardiovascular events; CKD plus abnormal stress MPI was also a strong predictor of cardiovascular events (non-CKD and SDS <2 vs. CKD and SDS ≥2, HR=15.9, p<0.001). Both CKD and myocardial ischemia detected by stress MPI are independent predictors for cardiovascular events. Coexistence of CKD and myocardial ischemia detected by stress MPI is more useful for short-term risk stratification of cardiovascular events. (author)

Same day injections of Tc-99m methoxy isobutyl isonitrile (hexamibi) for myocardial tomographic imaging: Comparison between rest-stress and stress-rest injection sequences

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Taillefer, R.; Gagnon, A.; Laflamme, L.; Leveille, J.; Phaneuf, D.C.

1989-01-01

It has been shown that both rest and stress 99m Tc-hexamibi myocardial perfusion imaging can be performed on the same day using two different doses injected within few h (the first one at rest followed by a second at stress). In order to evaluate and compare 2 sequences (rest-stress and stress-rest) of 99m Tc-hexamibi injections performed the same day, 18 patients with either abnormal 201 Tl myocardial scan or abnormal coronary angiography were studied with 2 99m Tc-hexamibi injections protocols. The rest-stress study was performed as follows: 7 mCi 99m Tc-hexamibi was injected at rest. Single photon emission computed tomography (SPECT) was performed 60 min later. Immediately after the rest study, patients were injected at peak stress with 25 mCi 99m Tc-hexamibi. Tomographic imaging was repeated 1 h later. Patients were submitted to the stress-rest protocol within 3 days. Tomographic imaging was done 1 h after a 7 mCi injection at stress. This study was followed by an injection of 25 mCi 99m Tc-hexamibi at rest, a tomographic study was performed 60 min later. Myocardial sections were reconstructed in horizontal long, vertical long, and short axes. Data analysis also included polar map representation. A total of 324 segments were interpreted blind by 3 observers, there was an agreement in 283/324 (87.3%) segments between the 2 protocols. However, 24 segments (7.4%) judged ischemic on rest-stress were called scars on stress-rest. In three patients, myocardial segments were judged normal on the rest image of the rest-stress protocol while they were found abnormal (false positive images) on the stress-rest sequence. Stress images from both protocols were judged similar in 17 patients. In conclusion, when using a short time interval (less than 2 h) between two 99m Tc-hexamibi injections, it is preferable to do a rest-stress sequence since the rest image performed initially represents a true rest study, which is not necessarily the case with the stress-rest sequence

Wall motion abnormality of myocardial infarction

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Hayashi, Senji; Tsuda, Takashi; Ojima, Kenji

1984-01-01

By use of the gated blood pool scan, we divided the left ventricular LAO 45 image into 8 sections with the center of the volume as the basal point, and devised a method of quantitative evaluation of the regional wall motion from 2 aspects: 1) wall movement and 2) phase abnormality. To evaluate the wall movement, we obtained the following indeces from count curves of each section: 1) EF1=(end-diastolic count-end-systolic count)/ end-diastolic count, 2) EF2=(maximum count-minimum count)/maximum count, and 3) the difference of the two (EF2-EF1). As indeces of the phase abnormality, the mean value of phases of the pixels (phase characteristics) and the standard deviation (variation) of each section were calculated. Furthermore, the phase delay of each section was calculated as the difference from the earliest phase value of the 8 sections. Control values and standard deviation were obtained from 8 healthy controls. By this method, we analyzed 20 patients with old myocardial infarction. And following results were obtained: 1. Applying this method, we could evaluate the regional wall motion of the left ventricle more precisely, and we considered it would be useful clinically. 2. The abnormal regional wall motion of old myocardial infarction were classified into 4 typical forms as follows: 1) the wall movement decreased extremely. 2) the wall movement decreased, but no phase delay recognized. 3) the wall movement did not decrease, but phase delay was recognized. 4) the wall movement decreased, and phase delay was recognized. (author)

Relation between exercise-induced ventricular arrhythmias and myocardial perfusion abnormalities in patients with intermediate pretest probability of coronary artery disease

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Elhendy, A.; Sozzi, F.B.; Van Domburg, R.T.; Bax, J.J.; Roelandt, J.R.T.C.

2000-01-01

We studied 302 patients (mean age 54±9 years, 152 men and 150 women) with intermediate pretest probability of CAD (range=0.25- 0.80, mean=0.43±0.20) by upright bicycle exercise stress test in conjunction with technetium-99m single-photon emission tomography (SPET) imaging. Exercise-induced VAs (frequent or complex premature ventricular contractions or ventricular tachycardia) occurred in 65 patients (22%). No significant difference was found between patients with and patient without VAs regarding the pretest probability of CAD (0.45±0.21 vs 0.43±0.20). Patients with exercise-induced VAs had a higher prevalence of perfusion abnormalities (52% vs 26%, P=0.002) and ischaemic electrocardiographic changes (31% vs 16%, P<0.05) compared to patients without VAs. A higher prevalence of perfusion abnormalities in patients with VAs was observed in both men (67% vs 35%, P<0.01) and women (38% vs 16%, P<0.05). However, the positive predictive value of exercise-induced VAs for the presence of myocardial perfusion abnormalities was higher in men than in women (67% vs 38%, P<0.05). The presence of abnormal myocardial perfusion was the only independent predictor of exercise-induced VAs (OR 2.2; 95% CI, 1.2-4.2) by multivariate analysis of clinical and stress test variables. It is concluded that in patients with intermediate pretest probability of CAD, exercise-induced VAs are predictive of a higher prevalence of myocardial perfusion abnormalities in both men and women. However, the positive predictive value of exercise-induced VAs for perfusion abnormalities is higher in men. Because of the underestimation of ischaemia by electrocardiographic changes, exercise-induced VAs should be interpreted as a marker of a higher probability of CAD. (orig./MG) (orig.)

Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT

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De Souza Leao Lima, R.; Machado, L.; Azevedo, A.B.; De Lorenzo, A.

2011-01-01

The objective of this study was to identify predictors of abnormal HR response to dipyridamole (DIP) in patients undergoing myocardial perfusion SPECT (MPS). Patients with a reduced heart rate (HR) response to DIP have higher cardiac mortality, but the mechanism is unknown. We studied 432 patients who underwent dual-isotope gated MPS. DIP (0.56 mg/kg) was infused over 4 min, and Tc-99m tetrofosmin was injected 3 min after the end of the infusion. MPS was semiquantitatively interpreted. Left ventricular ejection fraction (LVEF) and volumes were automatically calculated. The population was categorized into quartiles according to HR ratio, and characteristics in each quartile were compared. Logistic regression analysis was performed to identify predictors of abnormal HR response, using the lowest quartile as the independent variable. Patients with abnormal HR response were more frequently without chest pain, with a history of chronic renal failure and taking digoxin. Baseline HR was higher and had fewer symptoms during stress. The stress and rest perfusion defects were greater, but reversibility was not; in addition, LVEF was lower. Multivariable logistic regression analysis demonstrated that the independent predictors of abnormal HR response were baseline HR and low LVEF. LV dysfunction is an independent predictor of abnormal HR response to DIP, and the association between low LVEF and low HR ratio may explain the link between abnormal HR ratio and increased mortality. (author)

Stress Induced Cardiomyopathy Triggered by Acute Myocardial Infarction: A Case Series Challenging the Mayo Clinic Definition.

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Christodoulidis, Georgios; Kundoor, Vishwa; Kaluski, Edo

2017-08-28

BACKGROUND Various physical and emotional factors have been previously described as triggers for stress induced cardiomyopathy. However, acute myocardial infarction as a trigger has never been reported. CASE REPORT We describe four patients who presented with an acute myocardial infarction, in whom the initial echocardiography revealed wall motion abnormalities extending beyond the coronary distribution of the infarct artery. Of the four patients identified, the mean age was 59 years; three patients were women and two patients had underlying psychiatric history. Electrocardiogram revealed ST elevation in the anterior leads in three patients; QTc was prolonged in all cases. All patients had ≤ moderately elevated troponin. Single culprit lesion was found uniformly in the proximal or mid left anterior descending artery. Initial echocardiography revealed severely reduced ejection fraction with relative sparing of the basal segments, whereas early repeat echocardiography revealed significant improvement in the left ventricular function in all patients. CONCLUSIONS This is the first case series demonstrating that acute myocardial infarction can trigger stress induced cardiomyopathy. Extensive reversible wall motion abnormalities, beyond the ones expected from angiography, accompanied by modest elevation in troponin and marked QTc prolongation, suggest superimposed stress induced cardiomyopathy.

Abnormal myocardial capillary density in apical hypertrophic cardiomyopathy can be assessed by myocardial contrast echocardiography

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Moon, Jeonggeun; Cho, In-Jeong; Shim, Chi-Young; Ha, Jong-Won; Jang, Yangsoo; Chung, Namsik; Rim, Se-Joong

2010-01-01

Myocardial ischemia and dysfunction can occur in hypertrophic cardiomyopathy (HCM) because of the high muscle-to-blood ratio, even without significant coronary artery disease. Microbubbles reside only in the intravascular space and myocardial video-intensity during systole results mostly from microbubbles within capillaries. The hypothesis explored in the present study was that an abnormal capillary density in apical HCM (ApHCM) can be demonstrated using myocardial contrast echocardiography (MCE). The 56 patients were investigated (31 males, age 58±9 years; 33 ApHCM, 9 hypertensive left ventricular hypertrophy [LVH], 14 controls). MCE was performed with low-mechanical-index power modulation imaging. Tissue Doppler imaging to assess myocardial contractile function was obtained at the mitral annulus (S'), and 99m Tc-MIBI single photon emission computed tomography (SPECT) was also performed. All ApHCM patients exhibited perfusion defects at the hypertrophied segments in the systolic phase during MCE, whereas SPECT showed normal or rather increased perfusion at those sites. The cyclic variation of video-intensity was exaggerated in ApHCM when compared with the LVH or control group (% of [systolic video-intensity]/[diastolic video-intensity]: 33.0±12.3%, 88.3±19.2% and 79.4±13.9%, respectively [P<0.05]). Concurrently, MCE cyclic variation and perfusion defect size were related to decreased S' (P<0.05 for all). A perfusion defect at the hypertrophied segment, representing abnormal myocardial capillary density, was observed in ApHCM patients during MCE. The extent of MCE cyclic variation and the perfusion defect size both correlate with decreased myocardial contractile property in ApHCM. (author)

Increased incidence and clinical correlation of persistently abnormal technetium pyrophosphate myocardial scintigrams following acute myocardial infarction in patients with diabetes mellitus

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Nicod, P.; Lewis, S.E.; Corbett, J.C.; Buja, L.M.; Henderson, G.; Raskin, P.; Rude, R.E.; Willerson, J.T.

1982-01-01

Persistently abnormal /sup 99m/Tc stannous pyrophosphate myocardial scintigrams (PPi+) appear to be associated with a relatively poor prognosis after acute myocardial infarction (AMI). To assess the incidence and implications of PPi+, we performed a retrospective analysis in 29 patients with and 25 patients without diabetes mellitus who had abnormal myocardial scintigrams within 4 days of AMI and who had follow-up scintigrams at least 3 months after hospital discharge. There were no significant differences between patients with and without diabetes as regards age, incidence of transmural or nontransmural AMI, or degree of left ventricular dysfunction after AMI. Persistently abnormal PPi+ occurred more commonly in patients with diabetes than in nondiabetic patients (18 of 29, 62%, compared to 3 of 25, 12%; p less than 0.001). Patients with chronic PPi+ had more frequent cardiac complications following hospital discharge (p less than 0.005) including death, recurrent AMI, unstable angina, and intractable congestive heart failure. Postmortem analysis in two patients with diabetes and chronic PPi+ revealed marked myocytolysis. Thus, patients with diabetes mellitus have an increased incidence of post-AMI persistently abnormal technetium (PPi+) scintigrams and relatively poor prognosis following myocardial infarction

Left ventricular function abnormalities as a manifestation of silent myocardial ischemia.

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Lambert, C R; Conti, C R; Pepine, C J

1986-11-01

A large body of evidence exists indicating that left ventricular dysfunction is a common occurrence in patients with severe coronary artery disease and represents silent or asymptomatic myocardial ischemia. Such dysfunction probably occurs early in the time course of every ischemic episode in patients with coronary artery disease whether symptoms are eventually manifested or not. The pathophysiology of silent versus symptomatic left ventricular dysfunction due to ischemia appears to be identical. Silent ischemia-related left ventricular dysfunction can be documented during spontaneous or stress-induced perturbations in the myocardial oxygen supply/demand ratio. It also may be detected by nitroglycerin-induced improvement in ventricular function or by salutary changes in wall motion following revascularization. Silent left ventricular dysfunction is a very early occurrence during ischemia and precedes electrocardiographic abnormalities. In this light, its existence should always be kept in mind when dealing with patients with ischemic heart disease. It can be hypothesized that because silent ischemia appears to be identical to ischemia with symptoms in a pathophysiologic sense, prognosis and treatment in both cases should be the same.

Comparision the value of detecting myocardial viability between low dose dobutamine stress MRI and echocardiography

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He Yi; Zhang Zhaoqi; Yu Wei; Miao Cuilian; Zhao Yike; Yan Zixu

2006-01-01

Objective: To Compare the diagnostic value between low dose dobutamine stress transthrotic echocardiography and low dose dobutamine stress MRI in detecting myocardial viability of chronic myocardial infarction. Methods: Rest and low dose dobutamine (5, 10 μg·kg -1 ·min -1 ) stress transthrotic echocardiography and cine-MRI were performed in 30 patients with chronic myocardial infarction. 24 patients underwent successful revascularization and 10 of them underwent another rest cine-MRI study to assess segmental myocardial functional recovery. Left ventricular were divided into 16 segments, the criteria of viability in different techniques is: MRI: dobutamine induced systolic wall thickening was ≥2 mm in akinetic or diskinetic segments at rest; Echocardiography: wall motion score reduced at least 1 after dobutamine stress in akinetic or' diskinetic segments at rest. Results: One hundren and eight segments showed wall motion abnormalities of 30 patients, 65 and 56 segments shows positive reaction, 43 and 52 segments shows negativereaction in MRI and echocardiography after dobutamine stress respectively. Kappa value of the two techniques is 0.75, concordance in both techniques is 88%. Twenty-four segments showed functional recovery, 14 segments remained dysfunction 3-6 months after revascularization, the sensitivity, specificity and accuracy of detecting myocardial viability in chronic myocardial infarction in MRI and echocardiography is 95.8% vs 79.2% (P>0.05), 85.7% vs 85.7% (P>0.05), 92.1% vs 81.6% (P>0.05) respectively. The sensitivity and accuracy of MRI is a little higher. Conclusion: The ability of detecting myocardial viability by both low dose dobutamine stress transthrotic echocardiography and low dose dobutamine stress MRI is similer, the sensitivity and accuracy of MRI is a little higher. (authors)

Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

International Nuclear Information System (INIS)

Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

1984-01-01

Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined

Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy.

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Eftekhari, Mohammad; Anbiaei, Robabeh; Zamani, Hanie; Fallahi, Babak; Beiki, Davood; Ameri, Ahmad; Emami-Ardekani, Alireza; Fard-Esfahani, Armaghan; Gholamrezanezhad, Ali; Seid Ratki, Kazem Razavi; Roknabadi, Alireza Momen

2015-01-01

Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right-sided cancer. To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the

Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi

2000-01-01

The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress 99m Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest 123 I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and 123 I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by 123 I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in 123 I-BMIPP). Eighteen normotensive patients with apical defect by 123 I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by 123 I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by 123 I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and 123 I-BMIPP imaging are useful for the identification of these patients. (author)

Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

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Mohammad Eftekhari

2015-01-01

Full Text Available Objective(s: Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed and 36 patients with right-sided cancer (controls] were enrolled. Dose-volume histogram (DVH [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46. In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03 and anterolateral (17.1% versus 2.8%, P=0.049 walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS of>3 was observed in twelve cases (34.3%, while in five of the controls (13.9%,(Odds ratio=1.3. There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial

Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease.

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Jiang, Wei; Samad, Zainab; Boyle, Stephen; Becker, Richard C; Williams, Redford; Kuhn, Cynthia; Ortel, Thomas L; Rogers, Joseph; Kuchibhatla, Maragatha; O'Connor, Christopher; Velazquez, Eric J

2013-02-19

The goal of this study was to evaluate the prevalence and clinical characteristics of mental stress-induced myocardial ischemia. Mental stress-induced myocardial ischemia is prevalent and a risk factor for poor prognosis in patients with coronary heart disease, but past studies mainly studied patients with exercise-induced myocardial ischemia. Eligible patients with clinically stable coronary heart disease, regardless of exercise stress testing status, underwent a battery of 3 mental stress tests followed by a treadmill test. Stress-induced ischemia, assessed by echocardiography and electrocardiography, was defined as: 1) development or worsening of regional wall motion abnormality; 2) left ventricular ejection fraction reduction ≥ 8%; and/or 3) horizontal or downsloping ST-segment depression ≥ 1 mm in 2 or more leads lasting for ≥ 3 consecutive beats during at least 1 mental test or during the exercise test. Mental stress-induced ischemia occurred in 43.45%, whereas exercise-induced ischemia occurred in 33.79% (p = 0.002) of the study population (N = 310). Women (odds ratio [OR]: 1.88), patients who were not married (OR: 1.99), and patients who lived alone (OR: 2.24) were more likely to have mental stress-induced ischemia (all p mental stress-induced ischemia (all p Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Comparison of Hyperemic Impedance Echocardiography with Dobutamine Stress Echocardiography to Detect Inducible Myocardial Ischemia: A Pilot Study.

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Patel, Jijibhoy J; Gupta, Ankur; Nanda, Navin C

2016-03-01

Stress echocardiography using exercise or pharmacological stressors is either contraindicated or associated with significant side effects in some patients. This pilot study was designed to evaluate a new technique, hyperemic impedance echocardiography (HIE). It is based on reactive coronary hyperemia when transient limb ischemia is induced by tourniquet inflation. We hypothesized that this physiologic coronary hyperemia can identify inducible myocardial ischemia by assessment of regional wall motion abnormalities on echocardiography when compared with dobutamine stress echocardiography (DSE). Twenty consecutive outpatients with suspected stable coronary artery disease (CAD) who underwent clinically indicated DSE were recruited for performance of HIE after informed consent was obtained. Standard graded dobutamine infusion protocol from 5 to 40 μg/kg per min was used for DSE. HIE was performed by inflating tourniquets at a pressure of 10 mmHg below the systolic blood pressure for 1 minute in three of four extremities at a time for total of four cycles. Echocardiography was performed immediately after the last rotating tourniquet deflation. DSE and HIE were classified as abnormal for development of new or worsening wall motion abnormality in at least one myocardial segment. Test characteristics were also determined for a subset of these patients (n = 12) who underwent clinically indicated coronary angiography. Hyperemic impedance echocardiography showed 86% sensitivity, 67% specificity, 86% positive predictive value, and 67% negative predictive value with a test accuracy of 80% to detect inducible myocardial wall motion abnormalities when compared with DSE. HIE also showed 83% sensitivity, 75% negative predictive value with a test accuracy of 66.7% for detection of significant (≥50% diameter stenosis) CAD on coronary angiography. In this pilot study, HIE was a feasible, safe, and promising method for detection of inducible myocardial ischemia by assessment of

Abnormal response to mental stress in patients with Takotsubo cardiomyopathy detected by gated single photon emission computed tomography

International Nuclear Information System (INIS)

Sciagra, Roberto; Genovese, Sabrina; Pupi, Alberto; Parodi, Guido; Bellandi, Benedetta; Antoniucci, David; Del Pace, Stefano; Zampini, Linda; Gensini, Gian Franco

2010-01-01

Persistent abnormalities are usually not detected in patients with Takotsubo cardiomyopathy (TTC). Since sympathetically mediated myocardial damage has been proposed as a causative mechanism of TTC, we explored whether mental stress could evoke abnormalities in these patients. One month after an acute event, 22 patients fulfilling all TTC diagnostic criteria and 11 controls underwent resting and mental stress gated single photon emission computed tomography (SPECT). Perfusion, wall motion, transient ischaemic dilation (TID) and left ventricular (LV) ejection fraction (EF) were evaluated. None of the controls showed stress-induced abnormalities. Mental stress evoked regional changes (perfusion defects and/or wall motion abnormality) in 16 TTC subjects and global abnormalities (LVEF fall >5% and/or TID >1.10) in 13; 3 had a completely negative response. TID, delta LVEF and delta wall motion score were significantly different in TTC vs control patients: 1.08 ± 0.20 vs 0.95 ± 0.11 (p < 0.05), -1.7 ± 6% vs 4 ± 5% (p < 0.02) and 2.5 (0, 4.25) vs 0 (0, 0) (p < 0.002), respectively. Mental stress may evoke regional and/or global abnormalities in most TTC patients. The abnormal response to mental stress supports the role of sympathetic stimulation in TTC. Mental stress could thus be helpful for TTC evaluation. (orig.)

Stress myocardial scintigraphy in coronary artery disease

International Nuclear Information System (INIS)

Hata, Noritake; Koumi, Shin-ichi; Yasutake, Masahiro; Imaizumi, Takahiro; Saito, Tsutomu; Kishida, Hiroshi; Hayakawa, Hirokazu

1991-01-01

To evaluate the clinical significance of asymptomatic ischemic heart disease, exercise electrocardiography and stress myocardial scintigraphy were performed. These were correlated with symptoms during exercise tests and histories of myocardial infarction (MI). The study subjects consisted of 70 patients with coronary artery disease, including 34 with MI, and 36 without MI but with angina pectoris. Stress tests were performed using bicycle ergometer under electrocardiographic monitoring throughout the test. Transient myocardial ischemia was confirmed by perfusion defects on thallium myocardial imaging demonstrated immediately after exercise, but not 3 hours after the stress test. Asymptomatic ST depression was observed in 18 of 34 patients with MI (53%) and in 21 of the 36 patients with angina (58%); however, transient myocardial perfusion defects were confimred in 61% of the patients with MI (11 of 18 patients), but in only 33% of those with angina (7 of 21 patients). The difference was statistically significant (p<0.05). It was suggested that there are some differences in the clinical significance of asymptomatic ST depression between the patients with MI and those without MI but with angina pectoris. (author)

Mental Stress-Induced-Myocardial Ischemia in Young Patients With Recent Myocardial Infarction: Sex Differences and Mechanisms.

Science.gov (United States)

Vaccarino, Viola; Sullivan, Samaah; Hammadah, Muhammad; Wilmot, Kobina; Al Mheid, Ibhar; Ramadan, Ronnie; Elon, Lisa; Pimple, Pratik M; Garcia, Ernest V; Nye, Jonathon; Shah, Amit J; Alkhoder, Ayman; Levantsevych, Oleksiy; Gay, Hawkins; Obideen, Malik; Huang, Minxuan; Lewis, Tené T; Bremner, J Douglas; Quyyumi, Arshed A; Raggi, Paolo

2018-02-20

Mental stress-induced myocardial ischemia (MSIMI) is frequent in patients with coronary artery disease and is associated with worse prognosis. Young women with a previous myocardial infarction (MI), a group with unexplained higher mortality than men of comparable age, have shown elevated rates of MSIMI, but the mechanisms are unknown. We studied 306 patients (150 women and 156 men) ≤61 years of age who were hospitalized for MI in the previous 8 months and 112 community controls (58 women and 54 men) frequency matched for sex and age to the patients with MI. Endothelium-dependent flow-mediated dilation and microvascular reactivity (reactive hyperemia index) were measured at rest and 30 minutes after mental stress. The digital vasomotor response to mental stress was assessed using peripheral arterial tonometry. Patients received 99m Tc-sestamibi myocardial perfusion imaging at rest, with mental (speech task) and conventional (exercise/pharmacological) stress. The mean age of the sample was 50 years (range, 22-61). In the MI group but not among controls, women had a more adverse socioeconomic and psychosocial profile than men. There were no sex differences in cardiovascular risk factors, and among patients with MI, clinical severity tended to be lower in women. Women in both groups showed a higher peripheral arterial tonometry ratio during mental stress but a lower reactive hyperemia index after mental stress, indicating enhanced microvascular dysfunction after stress. There were no sex differences in flow-mediated dilation changes with mental stress. The rate of MSIMI was twice as high in women as in men (22% versus 11%, P =0.009), and ischemia with conventional stress was similarly elevated (31% versus 16%, P =0.002). Psychosocial and clinical risk factors did not explain sex differences in inducible ischemia. Although vascular responses to mental stress (peripheral arterial tonometry ratio and reactive hyperemia index) also did not explain sex differences in

[Clinical significance of myocardial 123I-BMIPP imaging in patients with myocardial infarction].

Science.gov (United States)

Narita, M; Kurihara, T; Shindoh, T; Honda, M

1997-03-01

In order to clarify the characteristics of fatty acid metabolism in patients with myocardial infarction (MI), we performed myocardial imaging with 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) and we compared these findings with exercise stress (Ex) and resting myocardial perfusion imaging with 99mTc-methoxyisobutylisonitrile (MIBI) and left ventricular wall motion index (WMI) which were obtained by left ventriculography. We studied 55 patients with MI, 14 patients with recent MI (RMI) and 41 patients with old MI (OMI), and myocardial images were divided into 17 segments and myocardial uptake of the radionuclide was graded from 0 (normal) to 3 (maximal abnormality). In 28 patients we compared segmental defect score (SDS) with WMI which were obtained by centerline method at the corresponded segments. As a whole, the mean total defect scores (TDSs) of BMIPP and Ex were similar and they were greater than the mean TDS of resting perfusion. In 30 patient (55%) TDS of BMIPP was greater than that of TDS of resting perfusion. In 24 patients perfusion abnormality developed by Ex and the location of BMIPP abnormality coincided with the abnormality of Ex. But in the other 6 patients Ex did not induce any abnormality and they were all RMI and infarcted coronary artery was patent. However in the group with TDS of BMIPP identical to TDS of resting perfusion (25 patients), 92% did not show myocardial perfusion abnormality after Ex. In the comparison of SDS and WMI, myocardial segments were divided into 3 groups; both SDSs of BMIPP and resting perfusion were normal or borderline abnormality (Group 1, 82 segments), SDS of resting perfusion was normal or borderline and SDS of BMIPP was definitely abnormal (Group 2, 10 segments) and both SDSs of BMIPP and resting perfusion were definitely abnormal (Group 3, 48 segments). In Group 1, WMS (-0.41 +/- 0.77) was significantly (p acid metabolism may appear in viable myocardium such as jeopardized myocardium and myocardium which

Clinical application of stress/rest myocardial perfusion imaging in the patients with 50%-75% coronary stenosis

International Nuclear Information System (INIS)

Han Pingping; Tian Yueqin; Fang Wei; Yang Minfu; Shen Rui; Wei Hongxing; Guo Xinhua; He Zuoxiang

2011-01-01

Objective: To evaluate the clinical application of stress/rest Mpi in the patients with 50%-75% coronary artery stenosis. Methods: The criteria for patient selection were that the patients should have at least one main coronary artery with stenosis more than 50%, and the maximal stenosis should be less than 75% according to Cage. The stress/rest Mpi was performed in 2 weeks before or after CAG. A total of 244 patients (178 males, 66 females) with mean age (57 ± 10) years were included in this study. Symptom restriction stress test was used and stress MPI was performed 1-1.5 h after 99 Tc m -MIBI (925 MBq) injection at the exercise peak. Rest MPI was performed within 48-72 h after stress MPI.Myocardial ischemia was diagnosed when there was a reduced uptake or even a defect in 2 different tomographic sections or in the same part of a myocardium in the continuous 2 slices. When there was an irreversible reduced uptake or defect, myocardial infarction was given as the final diagnosis. No reduced uptake or defect in all slices was shown as normal. The impact of MPI images on the selection for optimal clinical therapy plans was also discussed. χ 2 test was used for statistical analysis. Results: A total of 340 coronary arteries with stenosis 50%-75% were found by CAG. According to stress/rest MPI results, 207 patients (84.8%)presented normal, 33 had myocardial ischemia, 3 had myocardial infarction, and 1 had both myocardial infarction and ischemia. In abnormal MPI images, there were 61 ischemic segments and 9 infarct segments,which were associated with 43 stenotic arteries (23 LAD, 10 LCX, and 10 RCA). Patients were divided into 2 groups according to the results of MPI: Group 1 with normal MPI (207/244, 84.8%) and Group 2 with abnormal MPI (37/244, 15.2%). In Group 1, 9 patients underwent coronary artery revascularization (PTCA or CABG), and the others had medical treatment. Eight patients had PTCA and 29 patients had medical treatment in Group 2. There was a

Exercise induced ST elevation and residual myocardial ischemia in previous myocardial infarction

International Nuclear Information System (INIS)

Shimonagata, Tsuyoshi; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Saito, Muneyasu; Sumiyoshi, Tetsuya

1987-01-01

The purpose of this study was to evaluate the clinical significance of stress induced ST elevation on infarcted area in 65 patients with previous myocardial infarction (single vessel disease) who had stress thallium scan. Stress induced ST changes on infarcted area were compared with quantitative assessment of myocardial ischemia (thallium ischemic score; TIS) and extent of myocardial infarction (defect score; DS) derived from circumferential profile analysis. In patients with previous myocardial infarction in less than 3 month from the onset (n = 36), left ventricular ejection fraction (LVEF) and extent of abnormal LV wall motion were not significantly different between patients with stress induced ST elevation ( ≥ 2 mm, n = 26) and those with stress induced ST elevation ( < 2 mm, n = 10), while, in patients with previous myocardial infarction in more than 3 month (n = 29), patients with stress induced ST elevation ( ≥ 2 mm, n = 15) showed left ventricular dyskinesis more frequently than those with ST elevation ( < 2 mm, n = 14). In addition, the former showed significantly higher DS and significantly lower TIS than the latter. In patients with previous myocardial infarction in less than 3 month, patients with ST elevation ( ≥ 2 mm, n = 15) with prominent upright T wave (n = 15) had transient thallium defect in infarcted area in 73 % and they had significantly higher LVEF and TIS than those with ST elevation ( < 2 mm, n = 11). These results indicated that ST elevation in infarcted area reflect different significance according to the recovery of injured myocardium and stress induced ST elevation with prominent upright T wave in infarcted area reflect residual myocardial ischemia in less than 3 month from the onset of myocardial infarction. (author)

Clinical significance of myocardial 123I-BMIPP imaging in patients with myocardial infarction

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi; Shindoh, Takashi; Honda, Minoru

1997-01-01

We studied 55 patients with myocardial infarction (MI), 14 patients with recent MI (RMI) and 41 patients with old MI (OMI), and myocardial images were divided into 17 segments and myocardial uptake of the radionuclide was graded from 0 (normal) to 3 (maximal abnormality). In 28 patients we compared segmental defect score (SDS) with wall motion index (WMI) which were obtained by centerline method at the corresponded segments. As a whole, the mean total defect scores (TDSs) of BMIPP and exercise stress (Ex) were similar and they were greater than the mean TDS of resting perfusion. In 30 patient TDS of BMIPP was greater than that of TDS of resting perfusion. In 24 patients perfusion abnormality developed by Ex and the location of BMIPP abnormality coincided with the abnormality of Ex. But in the other 6 patients Ex did not induce any abnormality and they were all RMI and infarcted coronary artery was patent. However in the group with TDS of BMIPP identical to TDS of resting perfusion (25 patients), 92% did not show myocardial perfusion abnormality after Ex. In the comparison of SDS and WMI, myocardial segments were divided into 3 groups; both SDSs of BMIPP and resting perfusion were normal or borderline abnormality (Group 1, 82 segments), SDS of resting perfusion was normal or borderline and SDS of BMIPP was definitely abnormal (Group 2, 10 segments) and both SDSs of BMIPP and resting perfusion were definitely abnormal (Group 3, 48 segments). In Group 1, WMS was significantly greater than those of Group 2 and Group 3. But there was no difference between Group 2 and 3. These findings suggested that in the segments with mismatch between BMIPP and resting perfusion reflects stunned myocardium. (K.H.)

Thallium-201 myocardial imaging in the detection of coronary artery disease

International Nuclear Information System (INIS)

McKillop, J.H.; Murray, R.G.; Turner, J.G.; Gray, H.W.; Bessent, R.G.; Lorimer, A.R.; Greig, W.R.

1978-01-01

Thallium-201 myocardial imaging can detect abnormalities of myocardial perfusion. Visual interpretation of the images is complicated by some inhomogeneity of tracer uptake normally present. Using a quantitative approach we have established the regional variation of Thallium-201 uptake present in 23 normal controls and applied the same technique to 49 patients who had undergone selective coronary arteriography with left ventriculography because of chest pain. Half of the patients with significant coronary artery disease had abnormal rest Thallium-201 images, usually corresponding to areas of abnormal wall motion at ventriculography. Stress Thallium-201 images were abnormal in over 90% of patients with coronary artery disease. The stress image abnormalities and the arteriographic lesions correlated well in most patients with single and double vessel disease but in triple vessel disease the correspondence between the two studies was poor. Two of a group of patients with normal coronary arteriograms had abnormal Thallium-201 images due to other myocardial pathology. Our technique was highly sensitive in the non-invasive detection of significant coronary artery disease in a group of patients with chest pain. A small number of positive studies were also encountered due to other myocardial disorders. (author)

Detecting Regional Myocardial Abnormalities in Patients With Wolff-Parkinson-White Syndrome With the Use of ECG-Gated Cardiac MDCT.

Science.gov (United States)

Lee, Hye-Jeong; Uhm, Jae-Sun; Joung, Boyoung; Hong, Yoo Jin; Hur, Jin; Choi, Byoung Wook; Kim, Young Jin

2016-04-01

Myocardial dyskinesia caused by the accessory pathway and related reversible heart failure have been well documented in echocardiographic studies of pediatric patients with Wolff-Parkinson-White (WPW) syndrome. However, the long-term effects of dyskinesia on the myocardium of adult patients have not been studied in depth. The goal of the present study was to evaluate regional myocardial abnormalities on cardiac CT examinations of adult patients with WPW syndrome. Of 74 patients with WPW syndrome who underwent cardiac CT from January 2006 through December 2013, 58 patients (mean [± SD] age, 52.2 ± 12.7 years), 36 (62.1%) of whom were men, were included in the study after the presence of combined cardiac disease was excluded. Two observers blindly evaluated myocardial thickness and attenuation on cardiac CT scans. On the basis of CT findings, patients were classified as having either normal or abnormal findings. We compared the two groups for other clinical findings, including observations from ECG, echocardiography, and electrophysiologic study. Of the 58 patients studied, 16 patients (27.6%) were found to have myocardial abnormalities (i.e., abnormal wall thinning with or without low attenuation). All abnormal findings corresponded with the location of the accessory pathway. Patients with abnormal findings had statistically significantly decreased left ventricular function, compared with patients with normal findings (p syndrome. These abnormal findings might reflect the long-term effects of dyskinesia, suggesting irreversible myocardial injury that ultimately causes left ventricular dysfunction.

Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

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Dona, Manjola; Massi, Lucia; Settimo, Leonardo; Bartolini, Matteo; Gianni, Gianluca; Pupi, Alberto; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy)

2011-03-15

The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. We prospectively enrolled 57 consecutive patients with post-stress EF drop {>=} 5 EF units and summed difference score (SDS) {<=} 1. They were followed up for more than 1 year and their outcome was compared with a group of sex- and age-matched controls with the same SDS but without EF decrease. During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p < 0.0001) between the event-free survival curves of the two groups. The event rate of patients with post-stress EF decrease {>=} 5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted. (orig.)

Meta-Analysis of Stress Myocardial Perfusion Imaging

Science.gov (United States)

2017-06-06

Coronary Disease; Echocardiography; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Magnetic Resonance Imaging; Myocardial Perfusion Imaging; Perfusion; Predictive Value of Tests; Single Photon Emission Computed Tomography; Positron Emission Tomography; Multidetector Computed Tomography; Echocardiography, Stress; Coronary Angiography

Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery.

Science.gov (United States)

Uebleis, C; Groebner, M; von Ziegler, F; Becker, A; Rischpler, C; Tegtmeyer, R; Becker, C; Lehner, S; Haug, A R; Cumming, P; Bartenstein, P; Franz, W M; Hacker, M

2012-10-01

There has been a lack of standardized workup guidelines for patients with congenital abnormal origin of a coronary artery from the opposite sinus (ACAOS). We aimed to evaluate the use of cardiac hybrid imaging using multi-detector row CT (MDCT) for coronary CT angiography (Coronary CTA) and stress-rest myocardial perfusion SPECT (MPS) for comprehensive diagnosis of symptomatic adult patients with ACAOS. Seventeen symptomatic patients (12 men; 54 ± 13 years) presenting with ACAOS underwent coronary CTA and MPS. Imaging data were analyzed by conventional means, and with additional use of 3D image fusion to allocate stress induced perfusion defects (PD) to their supplying coronary arteries. An anomalous RCA arose from the left anterior sinus in eight patients, an abnormal origin from the right sinus was detected in nine patients (5 left coronary arteries, LCA and 4 LCx). Five of the 17 patients (29%) demonstrated a reversible PD in MPS. There was no correlation between the anatomical variants of ACAOS and the presence of myocardial ischemia. Image fusion enabled the allocation of reversible PD to the anomalous vessel in three patients (two cases in the RCA and the other in the LCA territory); PD in two patients were allocated to the territory of artery giving rise to the anomalies, rather than the anomalies themselves. In a small cohort of adult symptomatic patients with ACAOS anomaly there was no relation found between the specific anatomical variant and the appearance of stress induced myocardial ischemia using cardiac hybrid imaging.

Abnormal myocardial free fatty acid utilization deteriorates with morphological changes in the hypertensive heart

International Nuclear Information System (INIS)

Nakayama, Hiroyuki; Morozumi, Takakazu; Nanto, Shinsuke

2001-01-01

The left ventricle's morphological adaptation to high blood pressure is classified into 4 patterns based on mass and wall thickness. The geometric changes caused by maladaptation to pressure overload possibly relate to progression of contractile dysfunction with abnormal energy metabolism. The present study assessed whether the geometric adaptation of the left ventricle (LV) to high blood pressure relates to changes in myocardial energy metabolism, especially free fatty acid (FFA) utilization. Thirty-five patients with essential hypertension underwent echocardiography and dual isotopes myocardial scintigraphy using iodine-123 labeled 15-p-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP, an analogue of a FFA) and thallium-201 (Tl-201). Systolic (endocardial fractional shortening; %FS) and diastolic indices (the ratio of early to atrial filling waves; E/A) of LV function were also assessed. Quantitative myocardial BMIPP uptake was evaluated by the BMIPP/Tl-201 myocardial uptake ratio (B/T). The subjects were divided into 4 groups based on LV mass and wall thickness: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR), and normal geometry (N). The %FS was lower in the EH group than in the other groups. The mitral E/A ratio in the CH group was lowest. B/T was significantly decreased in the EH group compared with the N group (p<0.05). B/T correlated with the mitral E/A ratio significantly (p<0.05, r=0.42), whereas there was no relationship between %FS and B/T. These results indicate that the geometric changes occurring in hypertensive hearts strongly correlate with alternations in cardiac function and with abnormal myocardial FFA metabolism, and that the latter is associated with diastolic abnormality, but not with systolic function. (author)

Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents.

Science.gov (United States)

Eisenmann, Eric D; Rorabaugh, Boyd R; Zoladz, Phillip R

2016-01-01

Cardiovascular disease (CVD) is the largest cause of mortality worldwide, and stress is a significant contributor to the development of CVD. The relationship between acute and chronic stress and CVD is well evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury (IRI). Conversely, chronic stress is arrhythmogenic and increases sensitivity to myocardial IRI. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions.

Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents

Science.gov (United States)

Eisenmann, Eric D.; Rorabaugh, Boyd R.; Zoladz, Phillip R.

2016-01-01

Cardiovascular disease (CVD) is the largest cause of mortality worldwide, and stress is a significant contributor to the development of CVD. The relationship between acute and chronic stress and CVD is well evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia–reperfusion injury (IRI). Conversely, chronic stress is arrhythmogenic and increases sensitivity to myocardial IRI. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions. PMID:27199778

Clinical significance of stress-induced ST segment changes in patients with previous myocardial infarction

International Nuclear Information System (INIS)

Futagami, Yasuo; Hamada, Masayuki; Makino, Katsutoshi; Ichikawa, Takehiko; Konishi, Tokuji

1984-01-01

To explain the clinical significance of stress(st)-induced ST-segment (ST) changes postinfarction, 93 patients with previous myocardial infarction (MI) were performed st- 201 Tl myocardial single photon emission computed tomography (SPECT) and compared ST changes with SPECT, coronary arteriographic and left ventriculographic findings. 30 out of 93 cases (32%) had ST depression, 20 (21.5%) had ST elevation, 9 (10%) had both ST depression and elevation and remaining 34 (36.5 %) had no significant ST changes. In single vessel disease, ST depression were noted in 29% (12/42), while in multivessel disease, 53% (27/51). 35 out of 39 cases (90%) with ST depression had transient perfusion defect but no apparent relation was noted between location of ST depression on ECG and region of transient perfusion defect in SPECT. All of 28 cases with ST elevation were noted in anterior MI cases, and 26 out of these showed severe LV wall motion abnormality in contrast left ventriculography and broad anterior permanent defect in SPECT. Only 15 cases (54%) showed slight redistribution. Thus, we conclude that in patients with previous MI, st-induced ST depression seems to reflect myocardial ischemia and ST elevation possibly related abnormal LV wall motion. (author)

Altered myocardial perfusion during dobutamine stress testing in silent versus symptomatic myocardial ischaemia assessed by quantitative MIBI SPET imaging

International Nuclear Information System (INIS)

Elhendy, A.; Geleijnse, M.L.; Roelandt, J.R.T.C.; Cornel, J.H.; Domburg, R.T van; Reijs, A.E.M.; Nierop, P.R.; Fioretti, P.M.

1996-01-01

The aim of the study was to compare the extent and severity of reversible underperfusion in silent versus painful myocardial ischaemia during the dobutamine stress test. A consecutive series of 85 patients with significant coronary artery disease and reversible perfusion defects on technetium-99m methoxyisobutylisonitrile single-photon emission tomography performed at rest and during high-dose dobutamine stress (up to 40 μg kg -1 min -1 ) were studied. The left ventricle was divided into six segments. An ischaemic perfusion score was derived quantitatively by subtracting the rest from the stress defect score. Patients with multivessel disease had a higher ischaemic score (610±762 vs 310±411, P<0.05) and a higher number of reversible perfusion defects (2.1±1.2 vs 1.1±0.8, P<0.01) than patients with single-vessel disease. Typical angina occurred in 37 patients (44%) during the test. There was no significant difference between patients with and patients without angina with respecft to age, gender, peak rate-pressure product, prevalence of previous myocardial infarction, diabetes mellitus, multivessel disease or number of stenotic coronary arteries. Stress, rest and ischaemic scores as well as the number and distribution of reversible defects were not different in patients with and patients without angina. Patients with angina more frequently had a history of typical angina before the test (43% vs 17%, P<0.01) and ST-segment depression during the test (54% vs 25%, P<0.01). It is concluded that in patients with coronary artery disease and ischaemia detected by dobutamine scintigraphy, the extent and severity of coronary artery disease and myocardial perfusion abnormalities are similar with or without angina during stess testing. (orig.)

Effectiveness of Myocardial Contrast Echocardiography Quantitative Analysis during Adenosine Stress versus Visual Analysis before Percutaneous Therapy in Acute Coronary Pain: A Coronary Artery TIMI Grading Comparing Study

Science.gov (United States)

Yang, Lixia; Mu, Yuming; Quaglia, Luiz Augusto; Tang, Qi; Guan, Lina; Wang, Chunmei; Shih, Ming Chi

2012-01-01

The study aim was to compare two different stress echocardiography interpretation techniques based on the correlation with thrombosis in myocardial infarction (TIMI ) flow grading from acute coronary syndrome (ACS) patients. Forty-one patients with suspected ACS were studied before diagnostic coronary angiography with myocardial contrast echocardiography (MCE) at rest and at stress. The correlation of visual interpretation of MCE and TIMI flow grade was significant. The quantitative analysis (myocardial perfusion parameters: A, β, and A × β) and TIMI flow grade were significant. MCE visual interpretation and TIMI flow grade had a high degree of agreement, on diagnosing myocardial perfusion abnormality. If one considers TIMI flow grade <3 as abnormal, MCE visual interpretation at rest had 73.1% accuracy with 58.2% sensitivity and 84.2% specificity and at stress had 80.4% accuracy with 76.6% sensitivity and 83.3% specificity. The MCE quantitative analysis has better accuracy with 100% of agreement with different level of TIMI flow grading. MCE quantitative analysis at stress has showed a direct correlation with TIMI flow grade, more significant than the visual interpretation technique. Further studies could measure the clinical relevance of this more objective approach to managing acute coronary syndrome patient before percutaneous coronary intervention (PCI). PMID:22778555

Acute stress decreases but chronic stress increases myocardial sensitivity to ischemic injury in rodents

Directory of Open Access Journals (Sweden)

Eric D Eisenmann

2016-04-01

Full Text Available Cardiovascular disease is the largest cause of mortality worldwide, and stress is a significant contributor to the development of cardiovascular disease. The relationship between acute and chronic stress and cardiovascular disease is well-evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury. Conversely, chronic stress is arrythmogenic and increases sensitivity to myocardial ischemia-reperfusion injury. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions.

Do thallium myocardial perfusion scan abnormalities predict survival in sarcoid patients without cardiac symptoms

International Nuclear Information System (INIS)

Kinney, E.L.; Caldwell, J.W.

1990-01-01

Whereas the total mortality rate for sarcoidosis is 0.2 per 100,000, the prognosis, when the heart is involved, is very much worse. The authors used the difference in mortality rate to infer whether thallium 201 myocardial perfusion scan abnormalities correspond to myocardial sarcoid by making the simplifying assumption that if they do, then patients with abnormal scans will be found to have a death rate similar to patients with sarcoid heart disease. The authors therefore analyzed complete survival data on 52 sarcoid patients without cardiac symptoms an average of eighty-nine months after they had been scanned as part of a protocol. By use of survival analysis (the Cox proportional hazards model), the only variable that was significantly associated with survival was age. The patients' scan pattern, treatment status, gender, and race were not significantly related to survival. The authors conclude that thallium myocardial perfusion scans cannot reliably be used to diagnose sarcoid heart disease in sarcoid patients without cardiac symptoms

The usefulness of preoperative exercise stress myocardial single photon emission CT with thallium-201 to predict the responses to coronary revascularization

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Minamino, Takazoh; Katoh, Osamu; Higashino, Yorihiko.

1989-01-01

To evaluate the usefulness of preoperative exercise stress (Ex) myocardial single photon emission CT (SPECT) with thallium-201 to predict the responses to coronary revascularization (CRV), Ex-SPECT's were obtained in 42 patients with coronary artery disease (CAD). In 34 patients angioplasty was performed and in 18 patients coronary bypass surgery was undergone. Before and after CVR, Ex-SPECT's were obtained both at immediately after Ex (Initial) and 3 hours later (RD) by the rotating gamma camera. Initial images before CRV showed definite perfusion defects (+3) in 76 myocardial segments. Perfusion abnormalities at RD images were graded into (+3 to 0) by visual interpretation. '+3' indicated fixed defect and '0' indicated no perfusion abnormality. At RD images 17 segments showed fixed defect and 59 segments showed improved perfusion more than one grade. After CRV, all 59 segments with improved perfusion at RD images showed improvement of perfusion in comparison with initial images before CRV. Out of 17 segments with fixed defect before CRV, 14 segments showed perfusion defect with +3, while 3 segments showed improved perfusion after CRV. These 3 segments had ECG evidence of myocardial infarction. In these 3 segments, Ex-SPECT's before CRV showed abnormally low myocardial Tl washout rate (WOR) despite they indicated fixed defect visually. On the contrary, other 14 segments with fixed defect showed normal WOR before CRV. In conclusion, visually interpreted Ex-SPECT's before CRV predict the myocardial perfusion after CRV in most of cases. In a small number (especially infarction segments) Ex-SPECT's before CRV cannot predict the improvement of myocardial perfusion after CRV by visual inspection, but WOR abnormality before CRV is useful to prospect their results. (author)

Abnormal myocardial free fatty acid utilization deteriorates with morphological changes in the hypertensive heart

Energy Technology Data Exchange (ETDEWEB)

Nakayama, Hiroyuki; Morozumi, Takakazu; Nanto, Shinsuke [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)] (and others)

2001-09-01

The left ventricle's morphological adaptation to high blood pressure is classified into 4 patterns based on mass and wall thickness. The geometric changes caused by maladaptation to pressure overload possibly relate to progression of contractile dysfunction with abnormal energy metabolism. The present study assessed whether the geometric adaptation of the left ventricle (LV) to high blood pressure relates to changes in myocardial energy metabolism, especially free fatty acid (FFA) utilization. Thirty-five patients with essential hypertension underwent echocardiography and dual isotopes myocardial scintigraphy using iodine-123 labeled 15-p-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP, an analogue of a FFA) and thallium-201 (Tl-201). Systolic (endocardial fractional shortening; %FS) and diastolic indices (the ratio of early to atrial filling waves; E/A) of LV function were also assessed. Quantitative myocardial BMIPP uptake was evaluated by the BMIPP/Tl-201 myocardial uptake ratio (B/T). The subjects were divided into 4 groups based on LV mass and wall thickness: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR), and normal geometry (N). The %FS was lower in the EH group than in the other groups. The mitral E/A ratio in the CH group was lowest. B/T was significantly decreased in the EH group compared with the N group (p<0.05). B/T correlated with the mitral E/A ratio significantly (p<0.05, r=0.42), whereas there was no relationship between %FS and B/T. These results indicate that the geometric changes occurring in hypertensive hearts strongly correlate with alternations in cardiac function and with abnormal myocardial FFA metabolism, and that the latter is associated with diastolic abnormality, but not with systolic function. (author)

Prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease

International Nuclear Information System (INIS)

Zhu Mei; Pan Zhongyun; Lin JInghui; Zhang Chunli; Nie Tao; Wang Yanfu

1998-01-01

Purpose: To evaluate the prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease (CAD). Methods: 69 patients with CAD underwent exercise myocardial perfusing imaging and exercise ECG test. The images of all of them were abnormal. 45 patients were angiographically proved CAD. Follow-up period ranged from 6∼110 months and even longer than 12 months for patients with no cardiac events (CE). Results: CE occurred in 15 patients during the follow-up period. The CE incidence was 8.7% per year. Cox regression analysis revealed that there was a good correlation between the number of myocardial segments with reversible defects and future CE. Comparing the results of 13 patients with small extent irreversible defects with the data obtained from normal subjects reported previously, there was no significant difference between two no-CE rates (x 2 = 0.09, P>0.05). Conclusions: Normal myocardial images and irreversible defects involving rather small areas predicted an excellent prognosis. The better predictor of future CE is the quantity of myocardial segments with reversible defect

Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

Energy Technology Data Exchange (ETDEWEB)

Weininger, Markus [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC (United States); Ramachandra, Ashok [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Rowe, Garrett W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Henzler, Thomas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

2012-12-15

Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

International Nuclear Information System (INIS)

Weininger, Markus; Schoepf, U. Joseph; Ramachandra, Ashok; Fink, Christian; Rowe, Garrett W.; Costello, Philip; Henzler, Thomas

2012-01-01

Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

Abnormal perfusion on myocardial perfusion SPECT in patients with Wolff-Parkinson-White syndrome

International Nuclear Information System (INIS)

Kang, Do Young; Cha, Kwang Soo; Han, Seung Ho; Park, Tae Ho; Kim, Moo Hyun; Kim, Young Dae

2005-01-01

Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkison-White) syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECT with Fitzpatrick's algorithm of electrophysiologic study and radiofrequency catheter ablation. Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients(mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent (11.0 ± 8.5%, range:3 ∼ 35%) and mild to moderate severity (-71 ± 42.7%, range:-217 ∼ -39%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patients with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but if did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome

Abnormal perfusion on myocardial perfusion SPECT in patients with Wolff-Parkinson-White syndrome

Energy Technology Data Exchange (ETDEWEB)

Kang, Do Young; Cha, Kwang Soo; Han, Seung Ho; Park, Tae Ho; Kim, Moo Hyun; Kim, Young Dae [Donga University College of Medicine, Busan (Korea, Republic of)

2005-02-15

Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkison-White) syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECT with Fitzpatrick's algorithm of electrophysiologic study and radiofrequency catheter ablation. Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients(mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent (11.0 {+-} 8.5%, range:3 {approx} 35%) and mild to moderate severity (-71 {+-} 42.7%, range:-217 {approx} -39%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patients with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but if did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

Comparison of stress-rest and rest-stress one day myocardial perfusion scintigraphies in detecting coronary artery diseases

International Nuclear Information System (INIS)

Bom, Hee Seung; Min, Jung Jun; Song, Ho Cheon; Kim, Ji Yeul

1997-01-01

It has been shown that both rest and stress myocardial perfusion imaging with technetium agents can be performed on the same day using two different doses injected within few hours. The purpose of this study was to compare the two protocols (stress-rest and rest-stress) in detecting coronary artery diseases. One hundred and sixty patients (101 males, 59 females, mean age 57±9 years) and 120 patients (79 males, 41 females, mean age 59±10 years) underwent stress-rest myocardial perfusion SPECT and rest-stress myocardial perfusion SPECT, respectively. All of them underwent both myocardial perfusion SPECT and coronary angiography within 1 month. A coronary stenosis was considered significant when it compromised the luminal diameter by ≥50%. The chi square test was used to compare differences in sensitivity, specificity and accuracy between the two groups. The overall sensitivity, specificity and accuracy of stress-rest protocol were 99%, 35% and 68%, respectively. Those of rest-stress protocol were 96%, 47% and 78%, respectively. There was no difference between the two protocols in identifying individual diseased coronary artery branches. Therefore, one day stress-rest and rest-stress myocardial SPECT using 99m Tc agents were comparable and were very sensitive tests in detecting coronary artery diseases

Myocardial stress in patients with acute cerebrovascular events

DEFF Research Database (Denmark)

Jespersen, C.M.; Hansen, J.F.

2008-01-01

Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third...

Influence of abnormal glucose metabolism on coronary microvascular function after a recent myocardial infarction

DEFF Research Database (Denmark)

Løgstrup, Brian B; Høfsten, Dan E; Christophersen, Thomas B

2009-01-01

OBJECTIVES: This study sought to assess the association between abnormal glucose metabolism and abnormal coronary flow reserve (CFR) in patients with a recent acute myocardial infarction (AMI). BACKGROUND: Mortality and morbidity after AMI is high among patients with abnormal glucose metabolism, ...... (140 microg/kg/min) to obtain the hyperemic flow profiles. The CFR was defined as the ratio of hyperemic to baseline peak diastolic coronary flow velocities. RESULTS: Median CFR was 1.9 (interquartile range [IQR] 1.4 to 2.4], and 109 (60%) patients had a CFR...

Role of myocardial perfusion single photon emission computed tomography in pediatric cardiology practice

Directory of Open Access Journals (Sweden)

Sundaram P

2009-01-01

Full Text Available Diagnostic and prognostic power of myocardial perfusion imaging in patients with coronary artery disease has been demonstrated with planar imaging which was further improvised with addition of gated SPECT and newer Technetium labeled myocardial perfusion tracers like SestaMIBI, Tetrofosmin. Myocardial perfusion abnormalities at rest and after stress are considered to be the best predictors of cardiac event-free survival in adults with ischemic heart disease. This article highlights various myocardial perfusion imaging (MPIradiopharmaceuticals, exercise procedures, pharmacological stress protocols, indications for MPI and myocardial perfusion patterns in children with some of the common congenital and acquired heart diseases.

Myocardial perfusion scintigraphy with exercise and pharmacological stress

Energy Technology Data Exchange (ETDEWEB)

Sundram, F X [General Hospital of Singapore, Dept. of Nuclear Medicine (Senegal)

1996-12-31

Cardiac studies including myocardial perfusion scintigraphy was begun in the Singapore General Hospital, nuclear medicine department in 1983. From a few patients per year using planar imaging, we have in 1994 studied 1500 patients for myocardial perfusion, using mainly SPECT (single-photon emission computerised tomography) and radionuclides such as Thallium-201, Technetium-99m sestamibi and Tc-99m tetrofosmin. Patients have been stressed using treadmill exercise or pharmacological agents; we have used dipyridamole, and dobutamine for pharmacological stress but have no experience with intravenous adenosine.

Myocardial perfusion scintigraphy with exercise and pharmacological stress

International Nuclear Information System (INIS)

Sundram, F.X.

1995-01-01

Cardiac studies including myocardial perfusion scintigraphy was begun in the Singapore General Hospital, nuclear medicine department in 1983. From a few patients per year using planar imaging, we have in 1994 studied 1500 patients for myocardial perfusion, using mainly SPECT (single-photon emission computerised tomography) and radionuclides such as Thallium-201, Technetium-99m sestamibi and Tc-99m tetrofosmin. Patients have been stressed using treadmill exercise or pharmacological agents; we have used dipyridamole, and dobutamine for pharmacological stress but have no experience with intravenous adenosine

Reversible myocardial ischaemia or irreversible myocardial fibrosis

International Nuclear Information System (INIS)

Mathey, D.; Hanrath, P.; Kupper, W.; Bleifeld, W.; Montz, R.; Knop, J.; Stritzke, P.; Kroeger, E.; Bleese, N.

1978-01-01

The results of biphasis 201 thallium ( 201 Tl) scanning were compared with those of coronary arteriography, left ventricular angiography and stress ECG in 56 patients with coronary artery disease and six with no evidence of heart disease. There were 104 201 Tl defects, 50 of them reversible. The defects were always located in the area supplied by a critically stenotic coronary artery. Correlation of regional wall motion with 201 Tl activity demonstrated that in all forms of abnormal wall motion there was either ischaemia or fibrosis. The resting LV angiogram thus does not make it possible to distinguish between myocardial ischaemia and fibrosis. Taking the LV angiogram as a standard, the rate of false-positive 201 Tl scintigrams was 5%, that of false-negative ones 23%. The biphasic 201 Tl scintigram was more sensitive than the stress ECG in detecting myocardial ischaemia. It furthermore made it possible to localize the ischaemic (or fibrotic) region within the LV and to estimate its size. (orig.) [de

The prognostic value of 99MTc-MIBI stress-rest myocardial perfusion imaging in patients suspected with coronary artery disease

International Nuclear Information System (INIS)

Wu Zhifang; Li Sijin; Liu Jianzhong; Zhang Wanchun

2004-01-01

Objective: To evaluate the prognostic value of 99mTc-MIBI stress-rest myocardial perfusion imaging (MPI) for patients suspected with coronary artery disease (CAD). Methods: 206 consecutive patients suspected with CAD (165 males, 41 females; age range 16-90 years, mean age 55.94±12.46 years) underwent 99mTc-MIBI stress-rest myocardial perfusion imaging (two days protocol), 57 pts with hypertension, 68 pts with hyperlipemia, 39 pts with diabetes and 62 pts with the family history of CAD. According to the imaging results, the 206 patients were divided into 3 groups. G1, normal, 135 pts; G2, reversible defects, 20 pts; G3, fixed defects, 51 pts. The mean time of follow-up was 33.25±14.95 (1-56) months. Results: The rate of cardiac events (CE) occurrence of the three groups was 1.5% (2/135), 65% ( 13/20) and 7.8% (4/51) respectively and there was significant difference between them. Kaplan-Meier survival curves analyzing the no-CE rates in the three groups, ischemic patients demonstrated a more significantly lower than normal and infarction ones in the no-CE rates(Log-rank statistic, chi-square 124.89, P <0.0001). The better predictor of future cardiac events is the reversible defect. Over all, 23.9% of the patients with abnormal stress MPI occurred cardiac events, but only 7.5% of the patients with abnormal rest ones did(chi-square 5.80, P =0.016). The prognoses of patients with normal stress MPI result were better than those with normal rest ones (1.5% versus 9.7%, chi-square 8.94, P =0.0028). Compared with rest MPI, the stress one is a better predictable method to analyze the patient' s condition and evaluate the prognosis. Conclusions: 99mTc-MIBI stress-rest myocardial perfusion imaging is a better Methods to evaluate the prognosis of patients suspected with CAD, and the rate of CE occurrence was 65% in reversible defects patients in this study. (authors)

Asymmetric septal hypertrophy of sporadic form with abnormal thallium perfusion and myocardial enzymes

International Nuclear Information System (INIS)

Nagata, Seiki; Minamikawa, Tetsuhiro; Park, Yung-Dae; Nishimura, Tsunehiko; Yutani, Chikao; Ohmori, Fumio; Sakakibara, Hiroshi; Nimura, Yasuharu

1986-01-01

Asymmetric septal hypertrophy with abnormal thallium scintigram and elevated cardiac enzymes were observed in five patients and were studied with special reference to the clinical significance of their clinicopathological features. They were not familial cardiomyopathy patients. Two of the five patients (Cases 1 and 2) exhibited the clinical features characteristic of hypertrophic cardiomyopathy without abnormal thallium perfusion and serum cardiac enzyme levels. A right endomyocardial biopsy for Case 1 disclosed myocardial fibrosis in addition to hypertrophy and disarray of myocardial fibers. The left ventricular cavities of two other patients (Cases 4 and 5) tended to be dilated with signs of impaired systolic function and asymmetric septal hypertrophy. A regional area of reduced thickness was observed in the medial portion of the left ventricular posterior wall of Case 4. The remaining case (Case 3) exhibited left ventricular dilatation and reduced left ventricular systolic function, disproportionate hypertrophy, and had clinical signs of congestive heart failure. Necropsy disclosed massive fibrosis and diffuse disarray of myocardial fibers. Some patients with familial hypertrophic cardiomyopathy progress to exhibit clinical features of dilated cardiomyopathy in the termimal stages, and have massive fibrosis of the myocardium histologically. Thallium scintigraphic abnormalities and elevated serum levels of cardiac enzymes, especially the LDH 1 isoenzyme, in patients with hypertrophic cardiomyopathy may be a meaningful indicator of such progression in its early stages. The five patients in the present study exhibited a variety of clinical and histological features which may comprise a spectrum of clinical conditions during the progression from hypertrophic cardiomyopathy to a condition like dilated cardiomyopathy, similar to that in familial patients. This progression and the factors promoting it should be studied further in the near future. (author)

Comparison between stress myocardial perfusion SPECT recorded with cadmium-zinc-telluride and Anger cameras in various study protocols

International Nuclear Information System (INIS)

Verger, Antoine; Karcher, Gilles; Djaballah, Wassila; Fourquet, Nicolas; Rouzet, Francois; Le Guludec, Dominique; Koehl, Gregoire; Roch, Veronique; Imbert, Laetitia; Poussier, Sylvain; Fay, Renaud; Marie, Pierre-Yves

2013-01-01

The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity. The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving 201 Tl (n = 120) or 99m Tc-sestamibi injected at low dose at stress ( 99m Tc-Low; stress/rest 1-day protocol; n = 110) or at high dose at stress ( 99m Tc-High; rest/stress 1-day or 2-day protocol; n = 46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min). Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, 201 Tl 92 %, 99m Tc-Low 86 %, 99m Tc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r = 0.80) and a little lower for ischaemic areas (r = 0.72), the latter being larger on Anger SPECT (p 201 Tl or 99m Tc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228 ± 101 kcounts) and dramatically enhanced with CZT SPECT (+279 ± 251 %). Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT. (orig.)

Myocardial ischemia in Kawasaki disease

International Nuclear Information System (INIS)

Fukuda, Tsuyoshi

1993-01-01

The detection of myocardial ischemia is essential for evaluation of patients with Kawasaki disease, especially who have had coronary artery lesions. To evaluate the clinical efficacy of Tl-201 single photon emission computed tomography (SPECT) after dipyridamole infusion (maximum dose 0.70 mg/kg) for detecting myocardial ischemia, 44 patients with Kawasaki disease aged 7.7±4.8 years at the study and 10 age matched controls were observed. In the Kawasaki disease group, significant coronary artery stenosis was observed in 14, coronary aneurysm without stenosis in 18, the regression of the coronary aneurysms in 2 and without coronary lesions in 10 patients. In 24 of 44 patients, treadmill exercise stress test was also performed at the same period. Myocardial ischemic changes were observed in 11 patients, all combined with significant coronary artery stenosis. The sensitivity of SPECT for detection of overall coronary stenosis was 79%, coronary that of treadmill exercise test was only 33% (p<0.001). Furthermore, among the patients having significant coronary stenosis, the severity score was significantly elevated in patients who had electrocardiographic abnormal Q wave compared to those without abnormal Q wave (51.0±38.8 versus 20.0±12.1, p<0.05). These data suggest that the pharmacological stress scintigraphy using dipyridamole injection provides not only the accurate detection but quantitative evaluation of myocardial ischemia in these patients. This noninvasive technique may become one of the most useful index for detection and follow-up of myocardial ischemia in Kawasaki disease. (author)

Pretest clinical diagnosis of coronary artery disease and stress myocardial perfusion scintigram

International Nuclear Information System (INIS)

Kasalicky, J.; Kovac, I.; Lanska, V.

2001-01-01

To assess the probability of perfusion defects at exercise stress myocardial perfusion SPECT scintigraphy from pretest clinical diagnosis (medical personal history, previous ergometric investigation). To determine the value of clinical factors for probability of scintigraphic defects with respect to avoiding unnecessary investigation in subjects with low probability of abnormal scintigrams. 2143 subjects (1235 men, 908 women) were investigated by SPECT perfusion scintigraphy at stepwise increasing exercise stress. They were divided into three groups with regard to their medical history and exercise test at scintigraphy: subjects without any signs of coronary artery disease (CAD), patients with high likelihood of CAD (i.e., typical anginal pain, in particular at stress, positive stress ECG changes, angiographically documented important CAD) and patients after myocardial infarction (MI). Important risk factors (hypertension, diabetes, age and sex), as well as the role of revascularisation procedures, were taken into account for multiple logistic regression in order to express their importance for the odds of scintigraphic defect visualisation. Perfusion scintigraphic defects (PSD) were found in 5.2% of subjects without signs of CAD, in contrast to patients with manifest CAD (68.8% with PSD) and in those after MI (90.2% with PSD). There were other important factors corroborating the likelihood of PSD (in decreasing order of importance): diabetes, male, ECG changes at stress, increasing age. Successful revascularisation improved scintigraphic images. The examination of CAD symptom-free subjects, in particular with atypical chest discomfort, is useless. SMPS in patients after documented MI is to be carried out for other intended purposes, not for CAD diagnosis only. SMPS is highly recommended in patients with CAD symptoms and high CAD probability in order to decide further treatment and prognosis. (author)

Dobutamine stress magnetic resonance imaging suffices for the demonstration of myocardial ischaemia and viability.

Science.gov (United States)

Lamers, F P L; van Dijkman, P R M; Kuijpers, Th J A; van Herpen, G

2003-02-01

We report three patients in whom dobutamine stress magnetic imaging (DS-MRI) was essential in assessing myocardial ischaemia. Two patients were referred to the cardiologist because of chest pain. Patient A had typical exertional angina and a normal resting electrocardiogram (ECG). Patient B had typical exercise-induced angina and had recently experienced an attack of severe chest pain at rest for 15 minutes. The ECG showed a complete left bundle branch block (LBBB). Patient C was referred for heart failure of unknown origin. There were no symptoms of chest pain during rest or exercise. Echocardiography in this patient demonstrated global left ventricular (LV) dilatation, systolic dysfunction and a small dyskinetic segment in the inferior wall. In all these patients exercise stress testing had failed to demonstrate myocardial ischaemia. Patients A and C produced normal findings whereas in patient B the abnormal repolarisation due to pre-existent LBBB precluded a diagnosis of ischaemia. Breath-hold DS-MRI was performed to study LV wall motion and wall thickening at rest through increasing doses of dobutamine. A test was considered positive for myocardial ischaemia if wall motion abnormalities developed at high-dose levels of the drug (20 μg/kg/min or more with a maximum of 40 μg/kg/min) in previously normal vascular territories or worsened in a segment that was normal at baseline. Recovery of wall thickening in a previously hypokinetic or akinetic segment at a low dose of dobutamine (5-10 μg/kg/min) was taken as proof of viability. Patients A and B developed hypokinesia progressing into akinesia at high-dose dobutamine in the anteroseptal area of the LV indicative of ischaemia. These findings were corroborated by coronary angiography demonstrating severe coronary artery disease which led to coronary artery bypass grafting (CABG) in patient A and balloon angioplasty in patient B. In patient C global recovery of LV contractions during low-dose dobutamine was

Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X

International Nuclear Information System (INIS)

Saghari, Mohsen; Assadi, Majid; Eftekhari, Mohammad; Yaghoubi, Mohammad; Fard-Esfahani, Armaghan; Malekzadeh, Jan-Mohammad; Sichani, Babak Fallhi; Beiki, Davood; Takavar, Abbas

2006-01-01

Cardiac syndrome X is defined by a typical angina pectoris with normal or near normal (stenosis <40%) coronary angiogram with or without electrocardiogram (ECG) change or atypical angina pectoris with normal or near normal coronary angiogram plus a positive none-invasive test (exercise tolerance test or myocardial perfusion scan) with or without ECG change. Studies with myocardial perfusion imaging on this syndrome have indicated some abnormal perfusion scan. We evaluated the role of myocardial perfusion imaging (MPI) and also the severity and extent of perfusion abnormality using Tc-99m MIBI Single Photon Emission Computed Tomography (SPECT) in these patients. The study group consisted of 36 patients with cardiac syndrome X. The semiquantitative perfusion analysis was performed using exercise Tc-99m MIBI SPECT. The MPI results were analyzed by the number, location and severity of perfusion defects. Abnormal perfusion defects were detected in 13 (36.10%) cases, while the remaining 23 (63.90%) had normal cardiac imaging. Five of 13 (38.4%) abnormal studies showed multiple perfusion defects. The defects were localized in the apex in 3, apical segments in 4, midventricular segments in 12 and basal segments in 6 cases. Fourteen (56%) of all abnormal segments revealed mild, 7(28%) moderate and 4 (16%) severe reduction of tracer uptake. No fixed defects were identified. The vessel territories were approximately the same in all subjects. The Exercise treadmill test (ETT) was positive in 25(69%) and negative in 11(30%) patients. There was no consistent pattern as related to the extent of MPI defects or exercise test results. Our study suggests that multiple perfusion abnormalities with different levels of severity are common in cardiac syndrome X, with more than 30 % of these patients having at least one abnormal perfusion segment. Our findings suggest that in these patients microvascular angina is probably more common than is generally believed

Diagnostic value of stress-rest myocardial perfusion imaging in detection of coronary disease in elderly patients

International Nuclear Information System (INIS)

Han Pingping; Tian Yueqin; Fang Wei; Shen Rui; Yang Minfu; Wei Hongxing; Guo Xinhua; He Zuoxiang

2009-01-01

Objective: Coronary artery disease is one of the most common causes of death in elderly people. Yet, definite diagnosis is a dilemma due to the variety of symptoms and signs. The aim of this study was to evaluate the diagnostic value of nuclear stress-rest myocardial perfusion imaging(MPI) in detection of coronary disease in the elderly. Methods: Two hundred and five elderly subjects (≥60 years old, average of 67 ± 5) who were suspected to have coronary disease, underwent both stress-rest myocardial perfusion imaging (185 with exercise stress and 20 with adenosine stress) and coronary angiography (CAG). All had no pereutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Coronary angiography was used as a 'golden standard' to evaluate the sensitivity, specificity and accuracy of the stress-rest myocardial perfusion imaging. χ 2 -test was used in data analysis with SPSS 15.0. Results: Among 205 patients. there were 57 patients with an abnormal CAG result and 148 patients with a normal result. Of the 57 patients, there were 30 one-, 19 two-, and 8 three-vessel stenosis. Fifteen were mild-, 17 were moderate-, 17 were severe stenosis, and 8 were totally occluded.About 63% (36/57) had positive stress-rest MPI. Of the 148 subjects who had a normal CAG, 135 had negative MPL. The sensitivity.specificity and accuracy of stress MPI were 63% (36/57), 91% (135/148) and 83% (171/205) in patient level.respectively. The di-agnostic sensitivities of stress-rest MPI for detection of one-, two-, and three-vessel stenosis were 57%(17/30), 58% (11/19) and 8/8, respectively. All 185 patients who underwent exemise stress MPI were divided into 2 groups according to whether the patients reached the target heart rate or not at the peak of the test. And 53 patients (29%) were group 1 (reached the target heart rate)and 132 patients (71%) were group 2 (did not reach the target heart rate). The sensitivity of group 1 wag higher than that of group 2, but with no

Influence of angiographic collateral circulation on myocardial perfusion in patients with chronic total occlusion of a single coronary artery and no prior myocardial infarction.

Science.gov (United States)

Aboul-Enein, Fatma; Kar, Saibal; Hayes, Sean W; Sciammarella, Maria; Abidov, Aiden; Makkar, Raj; Friedman, John D; Eigler, Neal; Berman, Daniel S

2004-06-01

The functional role of various angiographic grades for coronary collaterals remains controversial. The aim of this study was to assess the influence of the Rentrop angiographic grading of coronary collaterals on myocardial perfusion in patients with single-vessel chronic total occlusion (CTO) and no prior myocardial infarction (MI). The study included 56 patients with single-vessel CTO and no prior MI who underwent rest-stress myocardial perfusion SPECT and coronary angiography within 6 mo. All patients had angiographic evidence of coronary collaterals. Patients were divided according to the Rentrop classification: Group I had grade 1 or 2 (n = 25) and group II had grade 3 collaterals (n = 31). Group I had a higher frequency of resting regional wall motion abnormalities on left ventriculography (52.6% vs. 19.2% [P = 0.019]). The mean perfusion scores of the overall population showed severe and extensive stress perfusion defects (summed stress score of 14.1 +/- 7.1 and summed difference score of 12.9 +/- 6.9) but minimal resting perfusion defects (summed rest score of 1.0 +/- 2.7). No perfusion scores differed between the 2 groups. The perfusion findings suggested that chronic stunning rather than hibernation is the principal cause of regional wall motion abnormalities in these patients. In the setting of single-vessel CTO and no prior MI, coronary collaterals appear to protect against resting perfusion defects. Excellent angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defects.

Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

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Oki, Glaucia Celeste Rossatto [Clinica Diagnoson and Hospital Aristides Maltez, Salvador, BA (Brazil). Servicos de Medicina Nuclear; Pavin, Elizabeth Joao; Parisi, Maria Candida R. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Endocrinology; Coelho, Otavio Rizzi; Almeida, Raitany C. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Cardiology; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario, E-mail: cdramos@unicamp.br [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Radiology. Service of Nuclear Medicine; Camargo, Edwaldo Eduardo [Hospital Sirio-Libanes, Campinas, SP (Brazil). Service of Nuclear Medicine

2013-01-15

Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with {sup 99m}Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

International Nuclear Information System (INIS)

Oki, Glaucia Celeste Rossatto; Pavin, Elizabeth Joao; Parisi, Maria Candida R.; Coelho, Otavio Rizzi; Almeida, Raitany C.; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario; Camargo, Edwaldo Eduardo

2013-01-01

Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99m Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

Myocardial contusion in patients with blunt chest trauma as evaluated by thallium 201 myocardial scintigraphy

International Nuclear Information System (INIS)

Bodin, L.; Rouby, J.J.; Viars, P.

1988-01-01

Fifty five patients suffering from blunt chest trauma were studied to assess the diagnosis of myocardial contusion using thallium 201 myocardial scintigraphy. Thirty-eight patients had consistent scintigraphic defects and were considered to have a myocardial contusion. All patients with scintigraphic defects had paroxysmal arrhythmias and/or ECG abnormalities. Of 38 patients, 32 had localized ST-T segment abnormalities; 29, ST-T segment abnormalities suggesting involvement of the same cardiac area as scintigraphic defects; 21, echocardiographic abnormalities. Sixteen patients had segmental hypokinesia involving the same cardiac area as the scintigraphic defects. Fifteen patients had clinical signs suggestive of myocardial contusion and scintigraphic defects. Almost 70 percent of patients with blunt chest trauma had scintigraphic defects related to areas of myocardial contusion. When thallium 201 myocardial scintigraphy directly showed myocardial lesion, two-dimensional echocardiography and standard ECG detected related functional consequences of cardiac trauma

Correlation between Stress Hyperglycemia and Short-Term Prognosis in non Diabetic Patients with Acute Myocardial Infarction

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Rafighdoust Amirhossein

2009-03-01

Full Text Available Background: Abnormal hyperglycemia is a common finding in early phase of acute myocardial infarction that is named as stress hyperglycemia. In this study we have evaluated primary blood sugar of non-diabetic patients with acute myocardial infarction at the time of admission to compare the early complications between patients with high or normal blood sugar. We aimed to find any relation between primary blood sugar and post MI complication rate. Materials and Methods: One hundred non-diabetic patients with acute myocardial infarction who were referred to heart emergency ward of Imam Reza Hospital (Mashhad, Iran were included in this study. According to primary blood glucose level, 50 patients with blood glucose > 126 mg/dl were compared with 50 patients with normal blood glucose level. All patients were evaluated during hospitalization and daily clinical examinations laboratory tests, and routine non-invasive assessments were done. The results were analyzed by SPSS software and the level of signification difference was described as p<0.05.Results: Sinus tachycardia, atrial fibrillation, bundle branch block, ventricular extrasystole, prolonged PR-interval and heart failure according to Klip classification and also according to echocardiographic index (EF<50 were statistically significant and more common in hyperglycemic patients (P<0.05. Thromboembolic and mechanical complications (papillary muscle dysfunction, pericarditis, phlebitis and angina were also more common in hyperglycemic group although the differences were not significant statistically. Conclusion: It seems that high rate of early complications in non-diabetic patients with acute myocardial infarction is directly related to primary hyperglycemia (stress hyperglycemia.

Comparison between stress myocardial perfusion SPECT recorded with cadmium-zinc-telluride and Anger cameras in various study protocols

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Verger, Antoine; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Djaballah, Wassila [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947, Nancy (France); Fourquet, Nicolas [Clinique Pasteur, Toulouse (France); Rouzet, Francois; Le Guludec, Dominique [AP-HP, Hopital Bichat, Department of Nuclear Medicine, Paris (France); INSERM U 773 Inserm and Denis Diderot University, Paris (France); Koehl, Gregoire; Roch, Veronique [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Imbert, Laetitia [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Centre Alexis Vautrin, Department of Radiotherapy, Vandoeuvre (France); Poussier, Sylvain [INSERM U947, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Fay, Renaud [INSERM, Centre d' Investigation Clinique CIC-P 9501, Nancy (France); Marie, Pierre-Yves [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U961, Nancy (France); Hopital de Brabois, CHU-Nancy, Medecine Nucleaire, Vandoeuvre-les-Nancy (France)

2013-03-15

The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity. The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving {sup 201}Tl (n = 120) or {sup 99m}Tc-sestamibi injected at low dose at stress ({sup 99m}Tc-Low; stress/rest 1-day protocol; n = 110) or at high dose at stress ({sup 99m}Tc-High; rest/stress 1-day or 2-day protocol; n = 46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min). Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, {sup 201}Tl 92 %, {sup 99m}Tc-Low 86 %, {sup 99m}Tc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r = 0.80) and a little lower for ischaemic areas (r = 0.72), the latter being larger on Anger SPECT (p < 0.001). This larger extent was mainly observed in 50 obese patients who were in the {sup 201}Tl or {sup 99m}Tc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228 {+-} 101 kcounts) and dramatically enhanced with CZT SPECT (+279 {+-} 251 %). Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT. (orig.)

Myocardial imaging. Coxsackie myocarditis

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Wells, R.G.; Ruskin, J.A.; Sty, J.R.

1986-09-01

A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

Myocardial imaging. Coxsackie myocarditis

International Nuclear Information System (INIS)

Wells, R.G.; Ruskin, J.A.; Sty, J.R.

1986-01-01

A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1

Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycem)a

International Nuclear Information System (INIS)

Shah, S.T.; Shah, C.F.A.; Shah, I.; Khan, S.B.; Hadi, A.; Gul, A.M.; Hafizullah, M.

2012-01-01

Objective: To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. Methodology: This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences (SPSS Ver. 15.0). Results: A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +- 9.748 (95% CI 57.39 - 55.31). Male were 58.1% (n=198). The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation (AF) 15.8%, ventricular tachycardia (VT) 11.7%, ventricular fibrillation (VF) 10.9% and complete heart block (CHB) 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema (CPE) 7.9% and cardiogenic shock (CS) 11.7%. Conclusion: Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively. (author)

Prevalence of silent myocardial ischaemia during exercise stress testing. Its relation to effort tolerance and myocardial perfusion abnormalities.

Science.gov (United States)

Fragasso, G; Sciammarella, M G; Rossetti, E E; Xuereb, R G; Xuereb, M; Bonetti, F; Carandente, O M; Margonato, A; Chierchia, S L

1992-07-01

The number of underperfused myocardial segments, the extent of coronary artery disease and the severity of impairment of coronary flow reserve were compared in 147 consecutive patients exhibiting painful or painless ischaemic ST segment depression on exercise testing. Of 147 patients, only 61 (41%) experienced angina (group 1) whilst 86 (59%) did not (group 2). In the two groups coronary disease was comparable for both extent and distribution, and neither the location of transient perfusion defects nor their relation to areas of old myocardial necrosis appeared to influence the presence or absence of chest pain. However, exercise duration, exercise time and rate-pressure product at the beginning of ischaemia were lower in group 1. Furthermore, a greater proportion of asymptomatic patients had only one ischaemic segment on 99mTc-MIBI perfusion scintigraphy. We conclude that: (1) in patients with effort angina and coronary disease, the incidence of electrocardiographic silent ischaemic events induced by exercise is similar to that observed in studies based on continuous ECG monitoring. (2) Exertional angina is more frequently associated with greater ischaemic areas and with more severe degrees of impairment of residual coronary flow reserve. (3) The presence of an old myocardial infarction does not appear to influence the incidence of ischaemic cardiac pain.

Cardioprotective effect of amlodipine in oxidative stress induced by experimental myocardial infarction in rats

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Sudhira Begum

2007-12-01

Full Text Available The present study investigated whether the administration of amlodipine ameliorates oxidative stress induced by experimental myocardial infarction in rats. Adrenaline was administered and myocardial damage was evaluated biochemically [significantly increased serum aspertate aminotransferase (AST, lactate dehydrogenase (LDH and malondialdehyde (MDA levels of myocardial tissue] and histologically (morphological changes of myocardium. Amlodipine was administered as pretreatment for 14 days in adrenaline treated rats. Statistically significant amelioration in all the biochemical parameters supported by significantly improved myocardial morphology was observed in amlodipine pretreatment. It was concluded that amlodipine afforded cardioprotection by reducing oxidative stress induced in experimental myocardial infarction of catecholamine assault.

Myocardial perfusion in silent myocardial ischemia

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

1989-01-01

To investigate myocardial perfusion in silent myocardial ischemia, we performed exercise stress myocardial tomography with thallium-201 (Tl) in 85 patients with coronary artery disease (CAD). Exercise stress myocardial tomography was obtained both immediately after exercise and three hours later. Patients were classified into two groups according to the presence (Symptomatic Group, n=36) or absence (Silent Group, n=49) of chest pain during exercise stress. Clinical features (age, gender and history of myocardial infarction) and arteriographically determined severity of CAD were the same in both groups. The extent of myocardial ischemia (% Ischemia) estimated by exercise stress myocardial tomography was the same in each group (30±10 % in Silent Group, 28±12 % in Symptomatic Group, NS). The severity of exercise-induced myocardial ischemia was expressed as a minimal value of myocardial Tl washout rate (minimal WOR) of each patient. Although exercise heart rate was identical in both groups, minimal WOR in Silent Group was significantly higher than that of Symptomatic Group (4±10% vs -16±14%, p<0.001). The study in patients who exhibited both silent and symptomatic ischemia showed the same results. These findings suggest that the severity of ischemia is a fundamental factor in determining the presence or absence of pain during exercise induced ischemia. (author)

Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

International Nuclear Information System (INIS)

Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B

2004-01-01

Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP

Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

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Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B [Kyungpook National University Hospital, Daegu (Korea, Republic of)

2004-07-01

Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP.

Cardiovascular outcomes after pharmacologic stress myocardial perfusion imaging.

Science.gov (United States)

Lee, Douglas S; Husain, Mansoor; Wang, Xuesong; Austin, Peter C; Iwanochko, Robert M

2016-04-01

While pharmacologic stress single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is used for noninvasive evaluation of patients who are unable to perform treadmill exercise, its impact on net reclassification improvement (NRI) of prognosis is unknown. We evaluated the prognostic value of pharmacologic stress MPI for prediction of cardiovascular death or non-fatal myocardial infarction (MI) within 1 year at a single-center, university-based laboratory. We examined continuous and categorical NRI of pharmacologic SPECT-MPI for prediction of outcomes beyond clinical factors alone. Six thousand two hundred forty patients (median age 66 years [IQR 56-74], 3466 men) were studied and followed for 5963 person-years. SPECT-MPI variables associated with increased risk of cardiovascular death or non-fatal MI included summed stress score, stress ST-shift, and post-stress resting left ventricular ejection fraction ≤50%. Compared to a clinical model which included age, sex, cardiovascular disease, risk factors, and medications, model χ(2) (210.5 vs. 281.9, P statistic (0.74 vs. 0.78, P stress score, stress ST-shift and stress resting left ventricular ejection fraction). SPECT-MPI predictors increased continuous NRI by 49.4% (P 3% annualized risk of cardiovascular death or non-fatal MI, yielded a 15.0% improvement in NRI (95% CI 7.6%-27.6%, P stress MPI substantially improved net reclassification of cardiovascular death or MI risk beyond that afforded by clinical factors. Copyright © 2016 Elsevier Inc. All rights reserved.

Value of myocardial perfusion SPECT in pediatric population

International Nuclear Information System (INIS)

Massardo, T.; Coll, C.; Prat, H.; Gonzalez, P.; Doggenweiller, P.; Castillo, M.E.; Solis, A.

2002-01-01

Isotopic myocardial perfusion studies are less frequently used in children than in adults and their indications are also different. Our goal was to analyze retrospectively the experience with stress perfusion myocardial SPECT in pediatric population. Method: Since 1998 to 2001, ten studies were performed to 5 girls and 3 boys. Their mean age was 7±3 years ranging from 1-11. Three of them presented abnormal coronary arteries pre and post surgical intervention with or without coil; three had Kawasaki disease with coronary aneurysms and the other two, congenital cardiopathies (Cantrell pentalogy and great vessel transposition,both with posterior left ventricular hypokinesia post surgery). Stress was obtained using dipyridamole infusion (0.56 mg/kg) in 6 cases and treadmill exercise using Bruce protocol in 4. All those tests were well tolerated. Sestamibi Tc99m was selected in 80% of the cases and Tl 201 in the rest. Only 2 small children required anesthesia during SPECT acquisition. Results: Stress EKG did not demonstrated ischemia in any case. Coronary angiography was performed only in 50% of the patients, it was concordant with SPECT features in all, two of those patients presented transient perfusion defects (one Kawasaki and one abnormal coronary artery with a fistulae).The repaired pentalogy presented ischemia and septal infarction; in that patient echocardiographic hipokinesia was concordant with fixed hypoperfusion. One case with abnormal coronary plus mitral regurgitation (without isotopic ischemia) was submitted to embolization posteriorly, obtaining motion improvement. Clinical outcome was concordant with the presence or absence of isotopic ischemia in the rest of the patients. Conclusion: SPECT myocardial perfusion was helpful in the therapeutic approach and in prediction of outcome in children

Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents

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Eisenmann, Eric D.; Rorabaugh, Boyd R.; Zoladz, Phillip R.

2016-01-01

Cardiovascular disease is the largest cause of mortality worldwide, and stress is a significant contributor to the development of cardiovascular disease. The relationship between acute and chronic stress and cardiovascular disease is well-evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury. Conversely, chronic stress is arrythmogenic and incr...

Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting

International Nuclear Information System (INIS)

Milvidaite, Irena; Kulakiene, Ilona; Vencloviene, Jone; Kinduris, Sarunas; Jurkiene, Nemira; Grizas, Vytautas; Navickas, Ramunas; Slapikas, Rimvydas

2014-01-01

The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. SPSS software for Windows, version 13.0. The t-test or the χ 2 -test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4–2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22–8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2–3.89; P = 0.01), and the summed stress score (SSS) of ≥4 (HR: 1.87; 95% CI: 1.02–3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06–1.48; P = 0.034). The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE

Role of redistribution and 24 hour reinjection images to assess myocardial viability in patients with acute myocardial infarction

International Nuclear Information System (INIS)

Yoon, Seok Nam; Pai, Moon Sun; Park, Chan H.; Yoon, Myung Ho; Choi, Byung Il

1998-01-01

We evaluated the importance of redistribution and 24 hour reinjection images in Tl-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). We performed dipyridamole stress-4 hour redistribution-24 hour reinjection Tl-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or 1 (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assessment in stress-redistribution and stress-reinjection images. On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fify two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reverseble on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress- reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. The 24 hour reinjection imaging is useful in the assessment of myocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other

Diagnostic value of exercise induced 18F-FDG myocardial metabolism scintigraphy in myocardial ischemia

International Nuclear Information System (INIS)

Shen Rui; He Zuoxiang; Shi Rongfang; Liu Xiujie; Tian Yueqin; Guo Feng; Wei Hongxing; Wu Yongjian; Qin Xuewen; Gao Runlin

2006-01-01

Objective: To evaluate the feasibility and diagnostic accuracy of exercise induced myocardial imaging with 18 F-fluorodeoxyglucose (FDG) in myocardial ischemia. Methods: Twenty-six patients with known or suspected coronary artery, disease (CAD) and with no prior myocardial infarction underwent simultaneous myocardial perfusion and metabolism imaging following intravenous injection of 99 Tc m -methoxy-isobutylisonitrile ( 99 Tc m -sestamibi) and 18 F-FDG at peak exercise. Subsequently rest perfusion imaging and coronary angiography (CAG) were performed in all patients. Exercise 18 F-FDG myocardial imaging was compared with 99 Tc m -sestamibi imaging and CAG. Results: In 22 patients with ≥50% narrowing over l coronary artery, 18 had perfusion abnormalities (sensitivity 82%), whereas 20 had abnormal myocardial 18 F-FDG uptake (sensitivity 91%, P>0.05). Patients with reversible (12 cases) or partial reversible (3 cases) perfusion abnormalities had increased myocardial 18 F-FDG uptake in abnormal perfusion segments. Compared with CAG, perfusion defect was seen in myocardial segments corresponding to 25 vascular territories of 51 vessels with ≥50% narrowing in 22 patients in 99 Tc m -sestamibi imaging (sensitivity 49%), whereas increased 18 F-FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). Conclusions: Exercise induced myocardial ischemia can be imaged directly with 18 F-FDG. Combined exercise 18 F-FDG and 99 Tc m -sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia as compared with exercise-rest perfusion imaging. (authors)

Evaluating the effect of PTCA by exercise stress myocardial perfusion imaging

International Nuclear Information System (INIS)

Lin Jinghui

1992-01-01

In this study, 44 patients after successful percutaneous transluminal coronary angioplasty (PTCA) were followed up by exercise stress myocardial perfusion imaging. In 28 patients with myocardial ischemia after PTCA, myocardial imaging of 75.0% patients reverted to normal or approximately normal. In 16 patients of myocardial infarction with ischemia after PTCA, myocardial imaging of only 37.5% patients reverted to normal or approximately normal, significantly less than myocardial ischemia. But the general efficacious incidence was similar in both groups. Most of 77 myocardial segments with complete or obvious redistribution returned to normal imaging after PTCA. During the follow-up coronary artery restenosis occurred in 6 cases, 5 of which were confirmed by coronary arteriography. Restenosis may be discovered as soon as possible, if a patient was reexamined by myocardial imaging 2-6 months after PTCA. The results of this study indicated that myocardial imaging is a noninvasive and reliable method for the assessment of PTCA therapeutic effect and follow up studies

Patterns of disturbed myocardial perfusion in patients with coronary artery disease. Regional myocardial perfusion in angina pectoris

International Nuclear Information System (INIS)

Selwyn, A.P.; Forse, G.; Fox, K.; Jonathan, A.; Steiner, R.

1981-01-01

Fifty patients who presented with angina pectoris were studied to examine the disturbances of regional myocardial perfusion during stress. Each patient underwent 16-point precordial mapping of the ECG during an exercise test, and coronary and left ventricular angiography. Regional myocardial perfusion was assessed using an atrial pacing test and a short-lived radionuclide, krypton-81m. Eleven patients had negative exercise tests and uniform increases in myocardial activity of krypton-81m of 98 +/- 18.0% during pacing. Ten patients performed 30,000-43,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and increases in myocardial activity of krypton-81m to remote and jeopardized myocardium at the onset of pacing. However, further pacing produced a decrease in activity in the affected segment of 68.0 +/- 9.0% accompanied by ST-segment depression and angina. Twelve patients achieved 26,000-32,000 J in positive exercise tests and had significant coronary artery disease. Atrial pacing produced increased activity of krypton-81m to remote myocardium. The jeopardized segment at first showed no change and then a decrease in regional activity of krypton-81m (89.0 +/- 17%) accompanied by ST-segment depression and chest pain. Seventeen patients achieved only 7000-22,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and developed decreases in regional activity of krypton-81m to the affected segment of myocardium starting at the onset of atrial pacing and decreasing by 88 +/- 0 7.0% below control. We conclude that different patterns of disturbed myocardial distribution of krypton-81m are present during stress-induced ischemia in patients with coronary artery disease. There was a close temporal relationship between these disturbances and ST-segment depression

Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

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Morariu Mirabela

2016-06-01

Full Text Available Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT during vasodilator stress test, associated with CT Coronary Angiography (CCTA has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the extent of the hypoperfused myocardial areas. Coronary artery anatomy and the Coronary Calcium Score was assessed for all 3 patients by performing CT Coronary Angiography. The combination of CT Angiography and adenosine stress CT myocardial perfusion imaging can accurately detect atherosclerosic lesions that cause perfusion abnormalities, compared with the combination of invasive angiography and single-photon emission computed tomography (SPECT.

Comparison of adenosine stress and exercise stress 201Tl myocardial perfusion imaging for diagnosis of coronary heart disease

International Nuclear Information System (INIS)

Chen Guibing; Wu Hua; Jiang Ningyi; Liu Sheng; Lu Xianping; Liang Jiugen; Zhang Hong

2007-01-01

Objective: The aim of this study was to compare the diagnostic values of adenosine and exercise stress 201 Tl myocardial perfusion imaging for detecting coronary heart disease (CHD). Methods: 41 patients with suspected CHD were randomly divided into two groups. In one group adenosine stress was submitted, the exercise stress myocardial SPECT was performed in another. Coronary angiography (CAG) was performed in each patient within 2 weeks before or after SPECT. The result of CAG was taken as 'gold standard of CHD. They compared the diagnostic value of two methods. Results: In adenosine group, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy are 92.86%, 57.14%, 81.25%, 80.00%, 80.95% respectively. In exercise stress group, are 100%, 60.0%, 71.43%, 100%, 80.00% respectively. Detection rates of coronary artery lesions were 66.67% and 72.22% in two groups respectively. Conclusion Adenosine stress testing and exercise stress testing 201 Tl myocardial perfusion imaging may provide similar value for detection of CHD. (authors)

The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia

NARCIS (Netherlands)

Lubbers, Daniel D.; Janssen, Caroline H. C.; Kuijpers, Dirkjan; Van Dijkman, Paul R. M.; Overbosch, Jelle; Willems, Tineke P.; Oudkerk, Matthijs

Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto,

Thallium-201 myocardial imaging in young adults with anomalous left coronary artery arising from the pulmonary artery

International Nuclear Information System (INIS)

Moodie, D.S.; Cook, S.A.; Gill, C.C.; Napoli, C.A.

1980-01-01

Anomalous origin of the left coronary artery from the pulmonary artery (Bland-Garland-White syndrome) may produce myocardial ischemia, infarction, and frequently death in infancy. Some patients, however, develop satisfactory coronary artery collaterals and are relatively asymptomatic into adulthood. Very little is known about their myocardial perfusion patterns. We studied three young adults with this condition using stress thallium-201 myocardial imaging. Electrocardiograms in two patients demonstrated old arterolateral myocardial infarctions. Preoperative stress exercise tests were positive in all three patients. Marked perfusion abnormalities were found in the proximal anterolateral wall in all patients, and one patient also had a posterolateral defect. Postoperatively, all stress tests returned to normal. Thallium imaging demonstrated improvement in ischemic areas, but old scars persisted

Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

International Nuclear Information System (INIS)

Padua, Rodrigo Donizete Santana de; Oliveira, Lucas Ferrari de; Marques, Paulo Mazzoncini de Azevedo; Groote, Jean-Jacques Georges Soares de; Castro, Adelson Antonio de; Ana, Lauro Wichert; Simoes, Marcus Vinicius

2008-01-01

To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

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Padua, Rodrigo Donizete Santana de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Div. de Cardiologia]. E-mail: rodrigo_dsp@hcrp.fmrp.usp.br; Oliveira, Lucas Ferrari de [Universidade Federal de Pelotas (UFPel), RS (Brazil). Inst. de Fisica e Matematica. Dept. de Tecnologia da Informacao; Marques, Paulo Mazzoncini de Azevedo [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Groote, Jean-Jacques Georges Soares de [Instituto de Ensino Superior COC, Ribeirao Preto, SP (Brazil). Lab. of Artifical Intelligence and Applications; Castro, Adelson Antonio de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina; Ana, Lauro Wichert [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Simoes, Marcus Vinicius [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina. Divisao de Cardiologia

2008-11-15

To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

Depressive disorder and gastrointestinal dysfunction after myocardial infarct are associated with abnormal tryptophan-5-hydroxytryptamine metabolism in rats.

Science.gov (United States)

Lu, Xiaofang; Wang, Yuefen; Liu, Chunyan; Wang, Yangang

2017-01-01

In this study, we investigated the relationship between tryptophan-5-hydroxytryptamine metabolism, depressive disorder, and gastrointestinal dysfunction in rats after myocardial infarction. Our goal was to elucidate the physiopathologic bases of somatic/psychiatric depression symptoms after myocardial infarction. A myocardial infarction model was established by permanent occlusion of the left anterior descending coronary artery. Depression-like behavior was evaluated using the sucrose preference test, open field test, and forced swim test. Gastric retention and intestinal transit were detected using the carbon powder labeling method. Immunohistochemical staining was used to detect indoleamine 2,3-dioxygenase expression in the hippocampus and ileum. High-performance liquid chromatography with fluorescence and ultraviolet detection determined the levels of 5-hydroxytryptamine, its precursor tryptophan, and its metabolite 5-hydroxyindoleacetic acid in the hippocampus, distal ileum, and peripheral blood. All data were analyzed using one-way analyses of variance. Three weeks after arterial occlusion, rats in the model group began to exhibit depression-like symptoms. For example, the rate of sucrose consumption was reduced, the total and central distance traveled in the open field test were reduced, and immobility time was increased, while swimming, struggling and latency to immobility were decreased in the forced swim test. Moreover, the gastric retention rate and gastrointestinal transit rate were increased in the model group. Expression of indoleamine 2,3-dioxygenase was increased in the hippocampus and ileum, whereas 5-hydroxytryptamine metabolism was decreased, resulting in lower 5-hydroxytryptamine and 5-hydroxyindoleacetic acid levels in the hippocampus and higher levels in the ileum. Depressive disorder and gastrointestinal dysfunction after myocardial infarction involve abnormal tryptophan-5-hydroxytryptamine metabolism, which may explain the somatic, cognitive

Depressive disorder and gastrointestinal dysfunction after myocardial infarct are associated with abnormal tryptophan-5-hydroxytryptamine metabolism in rats.

Directory of Open Access Journals (Sweden)

Xiaofang Lu

Full Text Available In this study, we investigated the relationship between tryptophan-5-hydroxytryptamine metabolism, depressive disorder, and gastrointestinal dysfunction in rats after myocardial infarction. Our goal was to elucidate the physiopathologic bases of somatic/psychiatric depression symptoms after myocardial infarction. A myocardial infarction model was established by permanent occlusion of the left anterior descending coronary artery. Depression-like behavior was evaluated using the sucrose preference test, open field test, and forced swim test. Gastric retention and intestinal transit were detected using the carbon powder labeling method. Immunohistochemical staining was used to detect indoleamine 2,3-dioxygenase expression in the hippocampus and ileum. High-performance liquid chromatography with fluorescence and ultraviolet detection determined the levels of 5-hydroxytryptamine, its precursor tryptophan, and its metabolite 5-hydroxyindoleacetic acid in the hippocampus, distal ileum, and peripheral blood. All data were analyzed using one-way analyses of variance. Three weeks after arterial occlusion, rats in the model group began to exhibit depression-like symptoms. For example, the rate of sucrose consumption was reduced, the total and central distance traveled in the open field test were reduced, and immobility time was increased, while swimming, struggling and latency to immobility were decreased in the forced swim test. Moreover, the gastric retention rate and gastrointestinal transit rate were increased in the model group. Expression of indoleamine 2,3-dioxygenase was increased in the hippocampus and ileum, whereas 5-hydroxytryptamine metabolism was decreased, resulting in lower 5-hydroxytryptamine and 5-hydroxyindoleacetic acid levels in the hippocampus and higher levels in the ileum. Depressive disorder and gastrointestinal dysfunction after myocardial infarction involve abnormal tryptophan-5-hydroxytryptamine metabolism, which may explain the

Clinical usefulness of myocardial iodine-123-15-(p-iodophenyl)-3(R,S)-methyl-pentadecanoic acid distribution abnormality in patients with mitochondrial encephalomyopathy based on normal data file in bull's-eye polar map

International Nuclear Information System (INIS)

Takahashi, Nobukazu; Mitani, Isao; Sumita, Shinichi

1998-01-01

Visual interpretation of iodine-123-beta-15-(p-iodophenyl)-3(R,S)-methyl-pentadecanoic acid ( 123 I-BMIPP) myocardial images cannot easily detect mild reduction in tracer uptake. Objective assessment of myocardial 123 I-BMIPP maldistributions at rest was attempted using a bull's-eye map and its normal data file for detecting myocardial damage in patients with mitochondrial encephalomyopathy. Six patients, two with Kearns-Sayre syndrome and four with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS), and 10 normal subjects were studied. Fractional myocardial uptake of 1 23 I-BMIPP was also measured by dynamic static imaging to assess the global myocardial free fatty acid. These data were compared with the cardiothoracic ratio measured by chest radiography and left ventricular ejection fraction assessed by echocardiography. Abnormal cardiothoracic ratio and lower ejection fraction were detected in only one patient with Kearns-Sayre syndrome. Abnormal fractional myocardial uptake was detected in two patients (1.61%, 1.91%), whereas abnormal regional 123 I-BMIPP uptake assessed by the bull's-eye map was detected in five patients (83%). All patients showed abnormal uptake in the anterior portion, and one showed progressive atrioventricular conduction abnormality and systolic dysfunction with extended 123 I-BMIPP abnormal uptake. The results suggest that assessment based on the normal data file in a bull's-eye polar map is clinically useful for detection of myocardial damage in patients with mitochondrial encephalomyopathy. (author)

Post-traumatic stress disorder symptoms in first-time myocardial infarction patients: roles of attachment and alexithymia.

Science.gov (United States)

Gao, Wen; Zhao, Jing; Li, Yang; Cao, Feng-Lin

2015-11-01

To explore the roles of attachment and alexithymia in the severity of post-traumatic stress disorder symptoms and to specify the relationship between sub-dimensions of attachment, alexithymia and posttraumatic stress disorder symptoms in patients with first-time myocardial infarction in mainland China. Patients experiencing myocardial infarction have a risk of developing post-traumatic stress disorder symptoms. However, there have been few studies on the roles of attachment and alexithymia. A cross-sectional survey design. Ninety-seven patients participated in the assessment of post-traumatic stress disorder symptoms, attachment and alexithymia from June-December in 2012. To assess post-traumatic stress disorder symptoms and their correlates, we administered the Post-traumatic Stress Disorder Checklist-Civilian Version, the 20-item Toronto Alexithymia Scale and the Experiences in Close Relationships Scale 5-17 days after the remission of first myocardial infarction attack. Twenty-five (25·77%) patients met the criteria of posttraumatic stress disorder symptoms. Greater attachment anxiety and avoidance were associated with more severe posttraumatic stress disorder symptoms. Except for externally oriented thinking, all dimensions of alexithymia were significantly correlated with post-traumatic stress symptoms. In the regression model, attachment anxiety and difficulties identifying feelings were found to be predictive and the total regression equation explained 24·2% variance of posttraumatic stress disorder symptoms among myocardial infarction patients. First-time myocardial infarction patients were at risk of developing posttraumatic stress disorder symptoms. Attachment anxiety and difficulties identifying feelings were positively associated with posttraumatic stress disorder symptoms in the early stage of myocardial infarction rehabilitation. It is essential to evaluate the causal relationship between attachment, alexithymia and posttraumatic stress disorder

Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes.

Science.gov (United States)

Chan, Christina; Elliott, John; Troughton, Richard; Frampton, Christopher; Smyth, David; Crozier, Ian; Bridgman, Paul

2013-01-01

Christchurch, New Zealand, was struck by 2 major earthquakes at 4:36 am on 4 September 2010, magnitude 7.1 and at 12:51 pm on 22 February 2011, magnitude 6.3. Both events caused widespread destruction. Christchurch Hospital was the region's only acute care hospital. It remained functional following both earthquakes. We were able to examine the effects of the 2 earthquakes on acute cardiac presentations. Patients admitted under Cardiology in Christchurch Hospital 3 week prior to and 5 weeks following both earthquakes were analysed, with corresponding control periods in September 2009 and February 2010. Patients were categorised based on diagnosis: ST elevation myocardial infarction, Non ST elevation myocardial infarction, stress cardiomyopathy, unstable angina, stable angina, non cardiac chest pain, arrhythmia and others. There was a significant increase in overall admissions (pearthquake. This pattern was not seen after the early afternoon February earthquake. Instead, there was a very large number of stress cardiomyopathy admissions with 21 cases (95% CI 2.6-6.4) in 4 days. There had been 6 stress cardiomyopathy cases after the first earthquake (95% CI 0.44-2.62). Statistical analysis showed this to be a significant difference between the earthquakes (pearthquake triggered a large increase in ST elevation myocardial infarction and a few stress cardiomyopathy cases. The early afternoon February earthquake caused significantly more stress cardiomyopathy. Two major earthquakes occurring at different times of day differed in their effect on acute cardiac events.

Myocardial perfusion as an indicator of graft patency after coronary artery bypass surgery

International Nuclear Information System (INIS)

Kolibash, A.J.; Call, T.D.; Bush, C.A.; Tetalman, M.R.; Lewis, R.P.

1980-01-01

Stress and resting myocardial perfusion were assessed in 38 patients who received 96 grafts. Stress perfusion was evaluated with thallium-201 and resting myocardial blood flow distribution with radiolabeled particles. When both stress and rest perfusion were normal, graft patency was 82% (51 of 62 grafts). Graft patency was also high (81%, 13 of 16) in areas where stress perfusion abnormalities resolved or become less apparent at rest. However, when stress perfusion defects remained unchanged at rest, the graf was likely to be occuluded (73%, 11 of 15). Maintenance of normal rest perfusion or improvement of rest perfusion postoperatively was also associated with a high graft patency rate (80%, 35 of 44), whereas the development of new rest perfusion defects postoperatively implied graft occlusion

Evaluation of hemodynamic significance of coronary fistulae. Diagnostic integration between coronary angiography and stress/rest myocardial scintigraphy

International Nuclear Information System (INIS)

Rubini, G.; Sebastiani, M.

2000-01-01

It is here reported on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography in evaluationing the hemodynamic significance of coronary arteriovenous fistulae. Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, trans thoracic echocardiography, stress electrocardiogram and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography. Stress/rest 99m Tc sestamibi myocardial perfusion single photon tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a seclusive stenosis of the right coronary artery and anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained

Stress-induced myocardial ischemia is associated with early post-stress left ventricular mechanical dyssynchrony as assessed by phase analysis of {sup 201}Tl gated SPECT myocardial perfusion imaging

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Chen, Chien-Cheng; Shen, Thau-Yun [Show Chwan Memorial Hospital, Department of Cardiology, Changhua (China); Chang, Ming-Che [Changhua Christian Hospital, Department of Nuclear Medicine, Changhua (China); Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Changhua (China); China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China); Chen, Wan-Chen [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Changhua (China); Kao, Chia-Hung [China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China); Chen, Ji [Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA (United States)

2012-12-15

In {sup 201}Tl SPECT myocardial perfusion imaging (MPI) data are acquired shortly after the stress injection to assess early post-stress left ventricle (LV) function. The purpose of this study was to use {sup 201}Tl SPECT MPI to investigate whether stress-induced myocardial ischemia is associated with LV mechanical dyssynchrony. Enrolled in the study were 75 patients who were referred for dipyridamole stress and rest {sup 201}Tl gated SPECT MPI. The early post-stress scan was started 5 min after injection, and followed by the rest scan 4 h later. The patients were divided into three groups: ischemia group (N = 25, summed stress score, SSS, {>=}5, summed rest score, SRS, <5), infarct group (N = 16, SSS {>=}5, SRS {>=}5) and normal group (N = 34, SSS <5, SRS <5). LV dyssynchrony parameters were calculated by phase analysis, and compared between the stress and rest images. In the ischemia group, LV dyssynchrony was significantly larger during stress than during rest. On the contrary, LV dyssynchrony during stress was significantly smaller than during rest in the normal and infarct groups. LV dyssynchrony during rest was significantly larger in the infarct group than in the normal and ischemia groups. There were no significant differences in LV dyssynchrony during rest between the normal and ischemia groups. Stress-induced myocardial ischemia caused dyssynchronous contraction in the ischemic region, leading to a deterioration in LV synchrony. Normal myocardium had more synchronous contraction during stress. The different dyssynchrony pattern between ischemic and normal myocardium early post-stress may aid the diagnosis of coronary artery disease using {sup 201}Tl gated SPECT MPI. (orig.)

Dobutamine stress thallium-201 single-photon emission tomography versus echocardiography for evaluation of the extent and location of coronary artery disease late after myocardial infarction

International Nuclear Information System (INIS)

Elhendy, A.; Bax, J.J.; Domburg, R.T. van; Cornel, J.H.; Roelandt, J.R.T.C.; Valkema, R.; Reijs, A.E.M.; Krenning, E.P.

1999-01-01

Dobutamine stress echocardiography and thallium-201 myocardial perfusion scintigraphy are clinically useful methods for the evaluation of coronary artery disease (CAD). However, the relative merits of these imaging modalities in the evaluation of the extent of CAD after myocardial infarction have not been well studied. The aim of this study was to compare the accuracy of dobutamine stress echocardiography and simultaneous 201 Tl single-photon emission tomography (SPET) imaging for the diagnosis and localization of CAD late after acute myocardial infarction. Dobutamine (up to 40 μg kg -1 min -1 )-atropine (up to 1 mg) stress echocardiography in conjunction with stress-reinjection 201 Tl SPET was performed for the evaluation of myocardial ischaemia in 90 patients with previous myocardial infarction who underwent coronary angiography. Significant CAD was predicted on bases of myocardial ischemia (new or worsening wall motion abnormalities on echocardiography and reversible perfusion defects on 201 Tl SPET). Significant CAD (≥ 50% luminal diameter stenosis) was detected in 73 (81%) patients. The sensitivity, specificity and accuracy of echocardiography in detecting remote ischaemia for the diagnosis of remote CAD (present in 53 patients) were, respectively, 79% (CI 70%-88%), 85% (CI 77%-93%) and 81% (CI 73%-90%), while the corresponding figures for 201 Tl SPET were 75% (CI 66%-85%), 78% (CI 69%-87%) and 76% (CI 67%-86%) respectively (P = NS vs echocardiography). The sensitivity, specificity and accuracy of echocardiography in detecting peri-infarction ischaemia for the diagnosis of infarct-related artery stenosis (present in 70 patients) were, rspectively, 77% (CI 68%-86%), 85% (CI 78%-92%) and 79% (CI 70%-87%) while the corresponding figures for 201 Tl SPET were 73% (CI 64%-82%), 85% (CI 78%-92%) and 76% (CI 67%-84%) respectively (P = NS vs echocardiography). The agreement between the two methods for the diagnosis of peri-infarction and remote ischaemia was 70

Financial stress and outcomes after acute myocardial infarction.

Directory of Open Access Journals (Sweden)

Sachin J Shah

Full Text Available Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction (AMI.We used prospective registry evaluating myocardial infarction: Event and Recovery (PREMIER data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year (symptoms, function, and quality of life (QoL, assessed by the Seattle Angina Questionnaire [SAQ] and Short Form [SF]-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care.Among 2344 AMI patients, 1241 (52.9% reported no financial stress, 735 (31.4% reported low financial stress, and 368 (15.7% reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health (SF-12 PCS mean difference -3.24, 95% Confidence Interval [CI]: -4.82, -1.66, mental health (SF-12 MCS mean difference: -2.44, 95% CI: -3.83, -1.05, disease-specific QoL (SAQ QoL mean difference: -6.99, 95% CI: -9.59, -4.40, and be experiencing angina (SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32 at 1 year post-AMI. While 1-year readmission rates were increased (Hazard Ratio = 1.50; 95%CI: 1.20, 1.86, 4-year mortality was no different.High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.

Technetium-99m sestamibi single-photon emission tomography detects subclinical myocardial perfusion abnormalities in patients with systemic lupus erythematosus

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Schillaci, O. [Nuclear Medicine, University of l`Aquila (Italy); Lagana, B.; Gentile, R.; Tubani, L.; Baratta, L. [Department of Clinical Medicine, University ``La Sapienza``, Rome (Italy); Danieli, R.; Scopinaro, F. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy)

1999-07-01

In patients with systemic lupus erythematosus, involvement of the cardiovascular system is the third leading cause of death. However, although autopsy studies have demonstrated a high incidence of abnormalities in both the myocardium and coronary vessels, clinical manifestations have been reported in only a small percentage of cases. The aim of this study was to evaluate myocardial perfusion in asymptomatic lupus patients using technetium-99m sestamibi single-photon emission tomography (SPET). Twenty-eight patients without overt cardiac involvement and risk factors were studied with {sup 99m}Tc-sestamibi SPET at rest and after dipyridamole infusion. Perfusion abnormalities were detected in 18 cases: six had persistent defects, three had reversible defects, seven had both persistent and reversible defects, and two showed rest defects which normalized on dipyridamole images (``reverse redistribution pattern``). Coronary angiography was performed in eight patients with positive {sup 99m}Tc-sestamibi SPET, and showed normal epicardial vessels in all the cases. These results indicate that {sup 99m}Tc-sestamibi SPET reveals a high prevalence (18 out of 28 patients in this study, i.e. 64%) of myocardial perfusion abnormalities in asymptomatic lupus patients, probably due to the primary immunological damage of this autoimmune disease. In conclusion, rest/dipyridamole {sup 99m}Tc-sestamibi SPET can be a useful non-invasive method to identify subclinical myocardial involvement in systemic lupus erythematosus, and patients potentially at risk of later cardiac events. (orig.) With 2 figs., 2 tabs., 21 refs.

Technetium-99m sestamibi single-photon emission tomography detects subclinical myocardial perfusion abnormalities in patients with systemic lupus erythematosus

International Nuclear Information System (INIS)

Schillaci, O.; Lagana, B.; Gentile, R.; Tubani, L.; Baratta, L.; Danieli, R.; Scopinaro, F.

1999-01-01

In patients with systemic lupus erythematosus, involvement of the cardiovascular system is the third leading cause of death. However, although autopsy studies have demonstrated a high incidence of abnormalities in both the myocardium and coronary vessels, clinical manifestations have been reported in only a small percentage of cases. The aim of this study was to evaluate myocardial perfusion in asymptomatic lupus patients using technetium-99m sestamibi single-photon emission tomography (SPET). Twenty-eight patients without overt cardiac involvement and risk factors were studied with 99m Tc-sestamibi SPET at rest and after dipyridamole infusion. Perfusion abnormalities were detected in 18 cases: six had persistent defects, three had reversible defects, seven had both persistent and reversible defects, and two showed rest defects which normalized on dipyridamole images (''reverse redistribution pattern''). Coronary angiography was performed in eight patients with positive 99m Tc-sestamibi SPET, and showed normal epicardial vessels in all the cases. These results indicate that 99m Tc-sestamibi SPET reveals a high prevalence (18 out of 28 patients in this study, i.e. 64%) of myocardial perfusion abnormalities in asymptomatic lupus patients, probably due to the primary immunological damage of this autoimmune disease. In conclusion, rest/dipyridamole 99m Tc-sestamibi SPET can be a useful non-invasive method to identify subclinical myocardial involvement in systemic lupus erythematosus, and patients potentially at risk of later cardiac events. (orig.)

Intravenous streptokinase therapy in acute myocardial infarction: Assessment of therapy effects by quantitative 201Tl myocardial imaging (including SPECT) and radionuclide ventriculography

International Nuclear Information System (INIS)

Koehn, H.; Bialonczyk, C.; Mostbeck, A.; Frohner, K.; Unger, G.; Steinbach, K.

1984-01-01

To evaluate a potential beneficial effect of systemic streptokinase therapy in acute myocardial infarction, 36 patients treated with streptokinase intravenously were assessed by radionuclide ventriculography and quantitative 201 Tl myocardial imaging (including SPECT) in comparison with 18 conventionally treated patients. Patients after thrombolysis had significantly higher EF, PFR, and PER as well as fewer wall motion abnormalities compared with controls. These differences were also observed in the subset of patients with anterior wall infarction (AMI), but not in patients with inferior wall infarction (IMI). Quantitative 201 Tl imaging demonstrated significantly smaller percent myocardial defects and fewer pathological stress segments in patients with thrombolysis compared with controls. The same differences were also found in both AMI and IMI patients. Our data suggest a favorable effect of intravenous streptokinase on recovery of left ventricular function and myocardial salvage. Radionuclide ventriculography and quantitative 201 Tl myocardial imaging seem to be reliable tools for objective assessment of therapy effects. (orig.)

The clinical value of adenosine triphosphate stress myocardial perfusion tomography for detecting coronary artery disease

International Nuclear Information System (INIS)

Yao Zhiming; He Qing; Qu Wanying; Yu Xue; Han Lijun; Yu Zhiguo; Li Wei; Zeng Xuezhai; Zhu Ming; Zhao Hongshan

2002-01-01

Objective: To study the clinical value of adenosine triphosphate stress myocardial perfusion tomography imaging (ATP-MPI) in detection of coronary artery disease (CAD). Methods: There were 278 patients underwent ATP-MPI, 51 patients of them also underwent coronary angiography (CAG). Seventy-three patients underwent stress-rest myocardial perfusion tomography imaging with multi-stage submaximal exercise test (ST-MPI) and CAG serving as control group. Results: 1) Side effects: there were 11 different symptoms and atrioventricular conduction block (10 patients), sinoatrial conduction block (2 patients) occurred during ATP stress. Allopathy or interruption of ATP stress did not happen. 2) The sensitivity and specificity of ATP-MPI in detection of CAD were 97.1% and 82.4%, respectively, and those in detection of ≥50% narrowing coronary artery were 91.0% and 94.7%, respectively. 3) In patients without myocardial infarction, the sensitivity and specificity of ATP-MPI in detection of myocardial ischemia were comparable to those of ST-MPI. Conclusion: ATP-MPI is an accurate, safe modality and is comparable to ST-MPI in the detection of CAD

Hypercholesterolemia aggravates myocardial ischemia reperfusion injury via activating endoplasmic reticulum stress-mediated apoptosis.

Science.gov (United States)

Wu, Nan; Zhang, Xiaowen; Jia, Pengyu; Jia, Dalin

2015-12-01

The effect of hypercholesterolemia on myocardial ischemia reperfusion injury (MIRI) is in controversy and the underlying mechanism is still not well understood. In the present study, we firstly detected the effects of hypercholesterolemia on MIRI and the role of endoplasmic reticulum (ER) stress-mediated apoptosis pathway in this process. The infarct size was determined by TTC staining, and apoptosis was measured by the TUNEL method. The marker proteins of ER stress response and ER stress-mediated apoptosis pathway were detected by Western blot. The results showed that high cholesterol diet-induced hypercholesterolemia significantly increased the myocardial infarct size, the release of myocardium enzyme and the ratio of apoptosis, but did not affect the recovery of cardiac function. Moreover, hypercholesterolemia also remarkably up-regulated the expressions of ER stress markers (glucose-regulated protein 78 and calreticulin) and critical molecules in ER stress-mediated apoptosis pathway (CHOP, caspase 12, phospho-JNK). In conclusion, our study demonstrated that hypercholesterolemia enhanced myocardial vulnerability/sensitivity to ischemia reperfusion injury involved in aggravation the ER stress and activation of ER stress-mediated apoptosis pathway and it gave us a new insight into the underlying mechanisms associated with hypercholesterolemia-induced exaggerated MIRI and also provided a novel target for preventing MIRI in the presence of hypercholesterolemia. Copyright © 2015 Elsevier Inc. All rights reserved.

Dobutamine stress MRI. Part I. Safety and feasibility of dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

International Nuclear Information System (INIS)

Kuijpers, Dirkjan; Janssen, Caroline H.C.; Oudkerk, Matthijs; Dijkman, Paul R.M. van

2004-01-01

The aim of the study was to evaluate safety and feasibility of dobutamine cardiovascular magnetic resonance (CMR) in patients with proven or suspected coronary artery disease. Dobutamine CMR was evaluated retrospectively in 400 consecutive patients with suspicion of myocardial ischemia. Dobutamine was infused using an incremental protocol up to 40 μg/kg body weight per minute. All anti-anginal medication was stopped 4 days before the CMR study and infusion time of dobutamine was 6 min per stage. Hemodynamic data, CMR findings and side effects were reported. Patients with contraindications to CMR (metallic implants and claustrophobia) were excluded from analysis. Dobutamine CMR was successfully performed in 355 (89%) patients. Forty-five (11%) patients could not be investigated adequately because of non-cardiac side effects in 29 (7%) and cardiac side effects in 16 (4%) patients. Hypotension (1.5%) and arrhythmias (1%) were the most frequent cardiac side effects. One patient developed a severe complication (ventricular fibrillation) at the end of the study. There were no myocardial infarctions or fatal complications of the stress test. The most frequent non-cardiac side effects were nausea, vomiting and claustrophobia. Age >70 years, prior myocardial infarction and rest wall motion abnormalities showed no significant differences with side effects (P>0.05). Dobutamine CMR is safe and feasible in patients with suspicion of myocardial ischemia. (orig.)

Dobutamine stress MRI. Part I. Safety and feasibility of dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia.

Science.gov (United States)

Kuijpers, Dirkjan; Janssen, Caroline H C; van Dijkman, Paul R M; Oudkerk, Matthijs

2004-10-01

The aim of the study was to evaluate safety and feasibility of dobutamine cardiovascular magnetic resonance (CMR) in patients with proven or suspected coronary artery disease. Dobutamine CMR was evaluated retrospectively in 400 consecutive patients with suspicion of myocardial ischemia. Dobutamine was infused using an incremental protocol up to 40 microg/kg body weight per minute. All anti-anginal medication was stopped 4 days before the CMR study and infusion time of dobutamine was 6 min per stage. Hemodynamic data, CMR findings and side effects were reported. Patients with contraindications to CMR (metallic implants and claustrophobia) were excluded from analysis. Dobutamine CMR was successfully performed in 355 (89%) patients. Forty-five (11%) patients could not be investigated adequately because of non-cardiac side effects in 29 (7%) and cardiac side effects in 16 (4%) patients. Hypotension (1.5%) and arrhythmias (1%) were the most frequent cardiac side effects. One patient developed a severe complication (ventricular fibrillation) at the end of the study. There were no myocardial infarctions or fatal complications of the stress test. The most frequent non-cardiac side effects were nausea, vomiting and claustrophobia. Age >70 years, prior myocardial infarction and rest wall motion abnormalities showed no significant differences with side effects (P>0.05). Dobutamine CMR is safe and feasible in patients with suspicion of myocardial ischemia. Copyright 2004 Springer-Verlag

Dobutamine stress MRI. Part I. Safety and feasibility of dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

Energy Technology Data Exchange (ETDEWEB)

Kuijpers, Dirkjan [State University and Academic Hospital Groningen, Department of Radiology, Groningen (Netherlands); Bronovo Hospital, Department of Radiology and Cardiology, Bronovolaan 1, P.O. Box 96900, The Hague (Netherlands); Janssen, Caroline H.C.; Oudkerk, Matthijs [State University and Academic Hospital Groningen, Department of Radiology, Groningen (Netherlands); Dijkman, Paul R.M. van [Bronovo Hospital, Department of Radiology and Cardiology, Bronovolaan 1, P.O. Box 96900, The Hague (Netherlands)

2004-10-01

The aim of the study was to evaluate safety and feasibility of dobutamine cardiovascular magnetic resonance (CMR) in patients with proven or suspected coronary artery disease. Dobutamine CMR was evaluated retrospectively in 400 consecutive patients with suspicion of myocardial ischemia. Dobutamine was infused using an incremental protocol up to 40 {mu}g/kg body weight per minute. All anti-anginal medication was stopped 4 days before the CMR study and infusion time of dobutamine was 6 min per stage. Hemodynamic data, CMR findings and side effects were reported. Patients with contraindications to CMR (metallic implants and claustrophobia) were excluded from analysis. Dobutamine CMR was successfully performed in 355 (89%) patients. Forty-five (11%) patients could not be investigated adequately because of non-cardiac side effects in 29 (7%) and cardiac side effects in 16 (4%) patients. Hypotension (1.5%) and arrhythmias (1%) were the most frequent cardiac side effects. One patient developed a severe complication (ventricular fibrillation) at the end of the study. There were no myocardial infarctions or fatal complications of the stress test. The most frequent non-cardiac side effects were nausea, vomiting and claustrophobia. Age >70 years, prior myocardial infarction and rest wall motion abnormalities showed no significant differences with side effects (P>0.05). Dobutamine CMR is safe and feasible in patients with suspicion of myocardial ischemia. (orig.)

Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease.

Science.gov (United States)

Arrighi, James A; Burg, Matthew; Cohen, Ira S; Soufer, Robert

2003-01-01

Mental stress (MS) is an important provocateur of myocardial ischemia in many patients with chronic coronary artery disease. The majority of laboratory assessments of ischemia in response to MS have included measurements of either myocardial perfusion or function alone. We performed this study to determine the relationship between alterations in perfusion and ventricular function during MS. Methods and results Twenty-eight patients with reversible perfusion defects on exercise or pharmacologic stress myocardial perfusion imaging (MPI) underwent simultaneous technetium 99m sestamibi single photon emission computed tomography (SPECT) MPI and transthoracic echocardiography at rest and during MS according to a mental arithmetic protocol. In all cases the MS study was performed within 4 weeks of the initial exercise or pharmacologic MPI that demonstrated ischemia. SPECT studies were analyzed visually with the use of a 13-segment model and quantitatively by semiautomated circumferential profile analysis. Echocardiograms were graded on a segmental model for regional wall motion on a 4-point scale. Of 28 patients, 18 (64%) had perfusion defects and/or left ventricular dysfunction develop during MS: 9 (32%) had myocardial perfusion defects develop, 6 (21%) had regional or global left ventricular dysfunction develop, and 3 (11%) had both perfusion defects and left ventricular dysfunction develop. The overall concordance between perfusion and function criteria for ischemia during MS was only 46%. Among 9 patients with MS-induced left ventricular dysfunction, 5 had new regional wall motion abnormalities and 4 had a global decrement in function. In patients with MS-induced ischemia by SPECT, the number of reversible perfusion defects was similar during both MS and exercise/pharmacologic stress (2.8 +/- 2.0 vs 3.5 +/- 1.8, P =.41). Hemodynamic changes during MS were similar whether patients were divided on the basis of perfusion defects or left ventricular dysfunction during MS

Myocardial perfusion imaging in hyperthrophic cardiomyopathy

International Nuclear Information System (INIS)

Moorin, B.

1998-01-01

Full text: Patients with Hyperthrophic Cardiomyopathy (HCM) frequently suffer from syncope and cardiac arrest which may lead to sudden death. This is most often caused by ventricular arrhythmia's in adults, however in young patients the mechanisms are thought to be different. Ischaemia may play a significant role even in young asymptomatic HCM patients. The mechanisms of ischaemic development in HCM differ from those in the 'normal' myocardium (Due to intramural small vessel abnormalities and abnormal myocellular architecture). In HCM the coronary microcirculation is most often affected and massive hypertrophy means more energy is required to promote contraction thus increasing oxygen demand and compounding the effects of any ischaemic changes. A case of a 12 year old HCM patient is presented who has symptoms of syncope associated with exercise whose mother died suddenly of cardiac arrest developed from HCM. A myocardial perfusion rest/stress study was undertaken to detect any underlying myocardial ischaemia. Myocardial perfusion scintigraphy demonstrates any reduction in the microcirculation in addition to that present in the macrocirculation, unlike angiography which will only detect the latter. In this case the scan clearly showed evidence of ischaemia in the lateral wall and this may be an explanation for her episodes of syncope. We suggest an algorithm or the routine work-up of young patients with HCM which makes aggressive use of myocardial perfusion imaging to detect ischaemic changes. This may identify patients who are at higher risk and will assist with treatment decisions. We feel myocardial perfusion scintigraphy is a sensitive non-invasive accurate method of detecting microcirculatory ischaemia and is thus invaluable in HCM patients

Prospective evaluation of stress myocardial perfusion imaging for pre-operative cardiac risk assessment

International Nuclear Information System (INIS)

Byrne, A.J.; Rowe, C.C.; Flannery, G.

2002-01-01

Full text: A prospective evaluation of patients who underwent stress myocardial perfusion imaging (MPI) to assess preoperative cardiac risk was undertaken. At the time of the scan patients were classified into 4 Clinical Risk groups (CR) based on known clinical data. On completion of the scan, the patient was then categorised into 4 Scan based Risk groups (SR), incorporating size of perfusion deficit, single versus multi-vessel disease and ejection fraction. Surgery at Austin and Repatriation Medical Centre within 6 months of scan and complications were identified using the hospital medical database. Major early cardiac events coded were death (cardiac related), myocardial infarction, unstable angina, acute pulmonary oedema, cardiac arrest, and urgent revascularisation. 208 patients have reached 6 months post-MPI scan. Of these 119 (57%) were identified as having surgery. Of the Scan Risk groups, 63% of normal, 57% of increased, and 47% of high and very high groups have had surgery. An abnormal scan is associated with a three-fold risk of cardiac complication (3.5% vs 11.3%). This is lower than most previous reports and may be due to higher representation of low risk surgical procedures (14% in this series), improved peri-operative care and/or the test result influence on management (suggested by decreasing surgical rate as SR estimate rose). Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

Myocardial ischemia and angina pectoris

International Nuclear Information System (INIS)

Selwyn, A.P.; Fox, K.M.; Jonathan, A.; Lavender, P.; Watson, I.

1981-01-01

Ambulatory monitoring of ST segment changes was performed in 60 patients presenting with angina, positive ECG stress tests and coronary artery disease, 85% of ischemic ECG events were asymptomatic, 37% occurred with no increase in heart rate and 15% of episodes either lasted 20 minutes or more or fluctuated in severity. A controlled pilot study in ten patients showed depression. Radionuclide studies in 50 patients with angina and coronary artery disease have shown that stress (i.e., atrial pacing) produced different patterns of disturbed regional myocardial perfusion related to the patient's exercise capacity and eventually leading to a decrease in regional myocardial perfusion during the ischemic episode. ST segment depression appeared only after the decrease in regional myocardial perfusion. These findings combined with past research suggest that patients with angina and coronary artery disease can suffer frequent asymptomatic disturbances of the regional myocardial perfusion. The frequency of these episodes and the time course for the recovery of the metabolic consequences mean that segments of ventricular myocardium may be constantly abnormal. The relative importance of changes in coronary tone and malfunction of platelets in the diseased coronary tree needs to be examined in clinical research. Pilot studies of antiplatelet agents have shown a significant beneficial effect on episodes of ischemia occurring at night and those occurring without any increase in heart rate. The techniques and observations in these patients with coronary artery disease all suggest that acute transient regional myocardial ischemia is caused by a variety of mechnisms. Further research using objective methods is required to discover the causes of ischemia and to rationalize treatment. (orig./MG) [de

Gadolinium enhanced cardiovascular magnetic resonance in Anderson-Fabry disease. Evidence for a disease specific abnormality of the myocardial interstitium.

Science.gov (United States)

Moon, James C C; Sachdev, Bhavesh; Elkington, Andrew G; McKenna, William J; Mehta, Atul; Pennell, Dudley J; Leed, Philip J; Elliott, Perry M

2003-12-01

Anderson-Fabry Disease (AFD), an X-linked disorder of sphingolipid metabolism, is a cause of idiopathic left ventricular hypertrophy but the mechanism of hypertrophy is poorly understood. Gadolinium enhanced cardiovascular magnetic resonance can detect focal myocardial fibrosis. We hypothesised that hyperenhancement would be present in AFD. Eighteen males (mean 43+/-14 years) and eight female heterozygotes (mean 48+/-12 years) with AFD underwent cine and late gadolinium cardiovascular magnetic resonance. Nine male (50%) had myocardial hyperenhancement ranging from 3.4% to 20.6% (mean 7.7+/-5.7%) of total myocardium; in males, percentage hyperenhancement related to LV mass index (r=0.78, P=0.0002) but not to ejection fraction or left ventricular volumes. Lesser hyperenhancement was also found in four (50%) heterozygous females (mean 4.6%). In 12 (92%) patients with abnormal gadolinium uptake, hyperenhancement occurred in the basal infero-lateral wall where, unlike myocardial infarction, it was not sub-endocardial. In two male patients with severe LVH (left ventricular hypertrophy) and systolic impairment there was additional hyperenhancement in other myocardial segments. These observations suggests that myocardial fibrosis occurs in AFD and may contribute to the hypertrophy and the natural history of the disease.

Prevalence of symptomatic and silent stress-induced perfusion defects in diabetic patients with suspected coronary artery disease referred for myocardial perfusion scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Prior, John O.; Calcagni, Maria-Lucia; Bischof Delaloye, Angelika [Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Nuclear Medicine, Lausanne (Switzerland); Monbaron, David; Ruiz, Juan [Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Endocrinology, Diabetology and Metabolism, Lausanne (Switzerland); Koehli, Melanie [Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Nuclear Medicine, Lausanne (Switzerland); Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Endocrinology, Diabetology and Metabolism, Lausanne (Switzerland)

2005-01-01

Silent myocardial ischaemia - as evaluated by stress-induced perfusion defects on myocardial perfusion scintigraphy (MPS) in patients without a history of chest pain - is frequent in diabetes and is associated with increased rates of cardiovascular events. Its prevalence has been determined in asymptomatic diabetic patients, but remains largely unknown in diabetic patients with suspected coronary artery disease (CAD) in the clinical setting. In this study we therefore sought (a) to determine the prevalence of symptomatic and silent perfusion defects in diabetic patients with suspected CAD and (b) to characterise the eventual predictors of abnormal perfusion. The patient population comprised 133 consecutive diabetic patients with suspected CAD who had been referred for MPS. Studies were performed with exercise (41%) or pharmacological stress testing (1-day protocol, {sup 99m}Tc-sestamibi, {sup 201}Tl or both). We used semi-quantitative analysis (20-segment polar maps) to derive the summed stress score (SSS) and the summed difference score (SDS). Abnormal MPS (SSS{>=}4) was observed in 49 (37%) patients (SSS=4.9{+-}8.4, SDS=2.4{+-}4.7), reversible perfusion defects (SDS{>=}2) in 40 (30%) patients [SSS=13.3{+-}10.9; SDS=8.0{+-}5.6; 20% moderate to severe (SDS>4), 7% multivessel] and fixed defects in 21 (16%) patients. Results were comparable between patients with and patients without a history of chest pain. Of 75 patients without a history of chest pain, 23 (31%, 95% CI=21-42%) presented reversible defects (SSS=13.9{+-}11.3; SDS=7.4{+-}1.2), indicative of silent ischaemia. Reversible defects were associated with inducible ST segment depression during MPS stress (odds ratio (OR)=3.2, p<0.01). Fixed defects were associated with erectile dysfunction in males (OR=3.7, p=0.02) and lower aspirin use (OR=0.25, p=0.02). Silent stress-induced perfusion defects occurred in 31% of the patients, a rate similar to that in patients with a history of chest pain. MPS could identify

Role of myocardial ischemia on exercise-induced ST elevation

International Nuclear Information System (INIS)

Saito, Muneyasu; Sumiyoshi, Tetsuya; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kouhei; Haze, Kazuo; Fukami, Ken-ichi; Hiramori, Katsuhiko

1986-01-01

Exercise-induced ST elevation in patients with previous myocardial infarction (MI) has been recognized to be related to left ventricular (LV) asynergy, however it is also recognized that myocardial ischemia can induce ST elevation. In this study, factors which determine the extent of ST elevation, with special reference to myocardial ischemia, was re-evaluated using quantitative analysis of stress myocardial scintigraphy (S-SG). Among 65 patients with previous anterior myocardial infarction and documented single vessel disease of left anterior descending artery (LAD), 19 patients who had exercise-induced ST elevation (ΔST ≥ 2.0 mm) had more abnormal Q waves (p < 0.01), lower LV ejection fraction (EF) (p < 0.01), more severe LV asynergy (p < 0.05) and less incidence of post-MI angina pectoris (AP) (p < 0.01), compared to those with ΔST < 2.0 mm, indicating that ST elevation is primarily related to LV asynergy. Correlation studies among clinical, angiographic and scintigraphic parameters show that ΔST was significantly related to a size of MI represented by Tl score or relative defect Tl activity and number of abnormal Q waves (No.Q), the magnitude of work load expressed by changes in double product (ΔDP) and intervals between the onset and exercise test, as well as myocardial ischemia expressed by the extent of redistribution (%RD) in S-SG. Among 23 patients with post-MI AP, ΔST significantly correlated with %RD (r = 0.47), indicating that myocardial ischemia can be a mechanism of exercise-induced ST elevation in patients with previous MI. Furtheremore, among those with ST elevation, concave-type ST elevation was more related to myocardial ischemia compared to convex-type ST elevation as expressed by the incidence of post-MI AP and/or significant redistribution. (J.P.N.)

Assessment of left ventricular function by electrocardiogram-gated myocardial single photon emission computed tomography using quantitative gated single photon emission computed tomography software

International Nuclear Information System (INIS)

Morita, Koichi; Adachi, Itaru; Konno, Masanori

1999-01-01

Electrocardiogram (ECG)-gated myocardial single photon emission computed tomography (SPECT) can assess left ventricular (LV) perfusion and function easily using quantitative gated SPECT (QGS) software. ECG-gated SPECT was performed in 44 patients with coronary artery disease under post-stress and resting conditions to assess the values of LV functional parameters, by comparison to LV ejection fraction derived from gated blood pool scan and myocardial characteristics. A good correlation was obtained between ejection fraction using QGS and that using cardiac blood pool scan (r=0.812). Some patients with myocardial ischemia had lower ejection fraction under post-stress compared to resting conditions, indicating post-stress LV dysfunction. LV wall motion and wall thickening were significantly impaired in ischemic and infarcted myocardium, and the degree of abnormality in the infarcted areas was greater than in the ischemia area. LV functional parameters derived using QGS were useful to assess post-stress LV dysfunction and myocardial viability. In conclusion, ECG-gated myocardial SPECT permits simultaneous quantitative assessment of myocardial perfusion and function. (author)

[Effect of edaravone on oxidative stress and myocardial fibrosis induced by isoproterenol in rats].

Science.gov (United States)

Wang, Shixiang; Lu, Zhifeng; Xu, Wei; Chen, Youquan; Chen, Ximing

2015-11-01

To investigate the effect of edaravone on oxidative stress and myocardial fibrosis induced by isoproterenol in rats. Fifty male SD rats were randomly divided into 5 groups, including a control group, a myocardial fibrosis model (established by injections of isopropyl adrenaline for 10 days) group, and 3 edaravone groups with edaravone treatment at low, medium, or high doses for 14 days. After the treatments, the rats were examined for the degree of myocardial fibrosis, left ventricular mass index (LVMI), collagen volume fraction (CVF), and myocardial contents of collagen I (Col I), collage III (Col III), hydroxyproline (Hyp), superoxide dismutase (SOD), malondialdehyde (MDA), and nitric oxide (NO); The expression of transforming growth factor-β1 (TGF-β1) in the myocardial tissues was examined by immunofluorescence assay and Western blotting. Compared with the control rats, the rat models of myocardial fibrosis showed significantly increased CVF and LVMI (P=0.000), which were lowered by edaravone treatments in a dose-dependent manner (Pedaravone; the contents of MDA was higher (P=0.000) and SOD and NO were lower in the model group (P=0.000), and edaravone treatments obviously increased SOD and NO contents (Pedaravone treatments (P=0.000). The myocardial content of MDA was positively correlated while SOD and NO were negatively with LVMI, CVF, Col I, Col III and Hyp; TGF-β1 was positively correlated with LVMI, CVF, Col I, Col III, Hyp and MDA but negatively with SOD and NO. Edaravone can relieve oxidative stress and inhibit TGF-β1 activation to ameliorate myocardial fibrosis in rats.

Evaluation of the severity of anterior myocardial infarction (single-vessel disease) by stress myocardial scanning

International Nuclear Information System (INIS)

Kobayashi, Mitsuru; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Hayashi, Makoto; Saito, Muneyasu; Sumiyoshi, Tetsuya

1986-01-01

Stress thallium-201 scanning was performed in 57 patients with ≥ 75 % stenosis in the left anterior descending artery. The ratio of lung uptake to heart uptake was defined as lung thallium uptake. For quantitative assessment of infarct size and the severity of ischemia, defect score and ischemic score were derived, respectively, from circumferential profile analysis. Lung thallium uptake at stress tended to increase with an increase in both defect and ischemic scores. The increase in lung thallium uptake also tended to be associated with a decrease in LVEF as determined by cardiac catheterization. The results indicate that stress thallium scanning is of value in the evaluation of the severity of myocardial infarction. (Namekawa, K.)

GAMMAGRAFÍA DE PERFUSIÓN MIOCÁRDICA EN MUJERES POSMENOPÁUSICAS CON ANGINA Y CORONARIAS EPICÁRDICAS ANGIOGRÁFICAMENTE NORMALES / Myocardial perfusion scintigraphy in postmenopausal women with angina and angiographically normal epicardial coronary

Directory of Open Access Journals (Sweden)

Sherien Sixto Fernández

2011-03-01

Full Text Available Introduction and Objectives: Microvascular angina is common in postmenopausal women. Myocardial ischemia was induced by stress testing, and reports have been published about the relationship between endothelial dysfunction and myocardial perfusion. The objective of this research was to determine whether myocardial ischemia can be evidenced by abnormalities in perfusion and function, as detected by myocardial scintigraphy in women with typical angina, normal coronary angiography and endothelial dysfunction. Methods: 59 women underwent lipid and endothelial function measurements by brachial artery ultrasound, in addition, a 24-hour ECG study (Holter. During the scintigraphy a stress-rest protocol was applied. Patients were divided into two groups according to presence (group I or absence (group II of myocardial perfusion defects. Results: 21 patients showed perfusion defects. 57 % of group I exhibited greater endothelial dysfunction. Only twelve patients showed reversible perfusion defects, and 75 % of the cases was associated with a reduction of post-stress left ventricular ejection fraction, greater than 5 %, and regional abnormalities of wall motion. Three patients in group I showed evidence of ischemia compared with four in Group II. Conclusions: The stress-induced ischemia was associated with a reduced post-stress ejection fraction and endothelial dysfunction in the studied women, and no ischemic changes in the Holter were found.

Clinical Significance of Reverse Redistribution Phenomenon on Delayed Tc-99m Tetrofosmin Myocardial Perfusion Imaging in Patients with Acute Myocardial Infarction

International Nuclear Information System (INIS)

Park, Soon Ah; Kim, Dae Weung; Kim, Chang Guhn; Jeong, Jin Won; Kim, Nam Ho; Yun, Kyeong Ho

2009-01-01

This study was performed to investigate the clinical significance of reverse redistribution (RR) phenomenon detected on delayed Tc-99m tetrofosmin myocardial single photon emission computed tomography (SPECT) in patients with acute myocardial infarction after revascularization. A Tc-99m tetrofrosmin myocardial SPECT was performed in 67 consecutive patients after revascularization for acute myocardial infarction. Myocardial SPECT imaging was performed for early imaging at 40 min and for delayed imaging at 180 min after reinjection at myocardial stress. Regional myocardial uptakes were scored by 4-point scoring in the left ventricular wall divided into 17 segments. Reverse redistribution was defined as an increase of more than 2 point in the activity score on the delayed image. Follow-up myocardial SPECT and coronary angiography (CAG) were performed 9 months later. On myocardial SPECT performed following revascularization, RR was observed in 100 of all 319 segments (31%) and in 43 patients (64%). The abnormalities of perfusion and regional wall motion were more severe in the patients with RR compared to those without RR (p<0.05). On follow-up myocardial SPECT, the myocardial perfusion, regional wall motion, and myocardial thickness were significantly improved in the patients with RR (p<0.05) however, these changes were not significant in those without RR. There was no significant difference between the patients with RR and those without RR in the occurrence of restenosis on CAG. In patients with acute myocardial infarction, the regions showing the RR phenomenon on delayed Tc-99m tetrofosmin SPECT may reflect viable myocardium and indicate recovery of salvaged myocardium

Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging.

Science.gov (United States)

Bybee, Kevin A; Lee, John; Markiewicz, Richard; Longmore, Ryan; McGhie, A Iain; O'Keefe, James H; Hsu, Bai-Ling; Kennedy, Kevin; Thompson, Randall C; Bateman, Timothy M

2010-04-01

A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS). Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was > or =100, > or =400, and > or =1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC. Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.

Predictive value of myocardial perfusion scintigraphy after stress in patients without previous myocardial infarction

International Nuclear Information System (INIS)

Tuner, D.A.; Battle, W.E.; Deshmukh, H.; Colandrea, M.A.; Snyder, G.J.; Fordham, E.W.; Messer, J.V.

1978-01-01

Seventy-five patients who had chest pain but no history or ECG evidence of myocardial infarction (MI) underwent myocardial-stress perfusion scintigraphy (MSPS) with thallium-201, treadmill-stress testing (TST), and coronary cineangiography (CA). The sensitivities of MSPS and TST for coronary stenosis greater than or equal to 75 percent were 68 percent and 71 percent, respectively; their specificities were 97 percent and 79 percent, respectively (0.1 greater than p greater than 0.05). When the character of a patient's chest pain is considered, Bayesian analysis leads to the following conclusions: MSPS can be useful in pre-CA screening of patients with chest pain but no MI if their pain is thought to be of uncertain or nonischemic origin; the sensitivity of Tl-201 MSPS is not sufficient for pre-CA screening of patients without MI who have typical or atypical angina pectoris; the sensitivity of MSPS would have to be approximately 95 percent in order for the test to be useful in pre-CA screening of patients who have atypical angina pectoris; MSPS may be superior to TST in these applications; and it is not clear that there is any advantage in combining MSPS and TST into a single screening test rather than using MSPS alone

Role of myocardial perfusion SPECT in asymptomatic diabetic patients

International Nuclear Information System (INIS)

Cho, I.; Chun, K.; Won, K.; Lee, H.; Park, J.; Shin, D.; Kim, Y.; Shim, B.; Lee, J.

2002-01-01

Purpose: It is important that early diagnosis and treatment of coronary artery disease in diabetic patients, but there are few reports on the prevalence of stress-induced myocardial perfusion abnormalities and the rates of cardiac event in patients with type 2 diabetes. We evaluated the scan findings on gated myocardial perfusion SPECT in asymptomatic diabetic patients. Methods: We performed pharmacological stress test and gated perfusion SPECT in 69 diabetic patients without cardiovascular symptom (mean age: 65 year, male 31 and female 38). Patients underwent two-day imaging protocol and stress study was performed injection of Tc-99m MIBI during adenosine infusion. We followed up these patients by reviewing medical records. Results: Fifty-two of 69 patients (74.5%) showed normal scan findings and 17 patients (24.6%) showed reversible or fixed perfusion defects. Three of 52 patients with normal scan findings showed decreased LV ejection fraction and decreased wall motion. Twenty-three patients with normal scan findings were possible to follow up for more than 1yr (mean time: 18.3±3.3 mo.) and they all had no cardiac event. Three patients with reversible perfusion defects were performed coronary angioplasty. Conclusion: Myocardial perfusion SPECT is a noninvasive method and maybe useful in early diagnosis and predicting prognosis in diabetic patients

Normal value of functional parameters in gated myocardial perfusion SPECT in patients with low risk of coronary artery disease: emory cardiac tool box program

Energy Technology Data Exchange (ETDEWEB)

Kang, D. Y.; Kim, M. H.; Kim, Y. D.; Kim, D. K. [Donga University College of Medicine, Busan (Korea, Republic of)

2002-07-01

Absolute value of the functional data of gated myocardial perfusion SPECT is necessary to determine that individual patient is normal or not. Tc-99m MIBI gated myocardial perfusion SPECT was performed using emory cardiac tool box program. All patients (M:F=15:36, age 64{+-}10 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded; previous angina or MI, ECG change with Q wave or ST-T change, diabetes mellitus, hypercholesterolemia, typical chest pain and hypertension. In all patients, myocardial mass is 117{+-}23 g in stress gated SPECT, 106{+-}22 g in stress ungated SPECT and 102{+-}21 g in rest ungated SPECT. EDV is 90{+-}28 ml, ESV 26{+-}20 ml, SV 66{+-}21 ml, EF 73{+-}10 % and TID 1.06{+-}0.14. Myocardial mass in rest ungated SPECT is significantly different between men and women (p=0.025). Myocardial mass is significantly different between stress gated SPECT and stress ungated SPECT (p=0.000), and between stress ungated SPECT and rest ungated SPECT (p=0.003). We provide normal value of functional parameters to determine the abnormality of individual patients in patients with low risk of coronary artery disease.

Comparison of diagnostic value of coronary artery disease between ATP-stress and exercise-stress thallium myocardial SPECT images

International Nuclear Information System (INIS)

Suzuki, Shigeo

1994-01-01

A study was made between adenosine triphosphate disodium (ATP)-stress thallium myocardial scintigrams and exercise-stress scintigrams to compare their respective extents and degree of defects. The subjects of the study were 33 ischemic heart disease patients, who received ATP stress and treadmill exercise stress with a mean interval of 25 days. ATP was infused for 5 minutes with an infusion rate of 0.16 or 0.18 mg per kg of body weight per minute. Thallium was injected three minutes after infusion. The percent-defect index (percentage of the extent and degree of the defects for all 33 patients), was calculated with visual scoring using a five-zone myocardial division method and semi-quantitative four-grade representation method for both the ATP and exercise SPECT images. The extent of the defects in ATP- and exercise-stress images was 51.5% and 44.2%, and that in redistribution images was 36.4% and 33.9%, respectively. The degree of defects in ATP- and exercise-stress images was 35.8% and 32.3%, while that in redistribution images was 20.8% and 17.2%, respectively (p=NS in all cases). In conclusion, the image quality of thallium SPECT with ATP stress was equivalent that of exercise stress, indicating identical diagnostic values for coronary lesions. (author)

Evaluation of viability of infarcted myocardium by low dose dobutamine stress echocardiography. Comparison with exercise stress 201Tl myocardial scintigraphy

International Nuclear Information System (INIS)

Nagahara, Toshihiro; Sakamoto, Kazunori; Sofue, Akira; Horiuchi, Toshimitsu; Yamazaki, Shigeki; Kuwako, Kenji

1999-01-01

Exercise stress 201 Tl myocardial single-photon emission computed tomography (SPECT) is recognized to be a excellent method for identifying viability after myocardial infarction, but it is expensive and needs a longer time for data acquisition than echocardiography. We therefore performed this study to evaluate the effectiveness of low dose (5-10 μg/kg/min) dobutamine stress echocardiography (DSE) in 30 patients (61±8 years old: 24 men and 6 women) within 4 weeks after myocardial infarction in identifying viable myocardium, compared to results obtained by SPECT. Defining an akinetic or dyskinetic segment obtained by rest echocardiography as a definite infarct area, altogether 96 segments out of 716 segments were shown to be infarct areas. Of these, 75 (78%) segments were identified as viable by DSE, and 77 (80%) by SPECT. Only 2 segments were shown to be discrepant on DSE and SPECT. Subsequently, the sensitivity, specificity and accuracy rates for DSE were 96%, 100% and 96%, respectively. In conclusion, DSE is as effective and useful as SPECT in the evaluation of viability after myocardial infarction. (author)

Quantitative analysis of exercise 201Tl myocardial emission CT in patients with coronary artery disease

International Nuclear Information System (INIS)

Okada, Mitsuhiro; Kawai, Naoki; Yamamoto, Shuhei

1984-01-01

The clinical usefulness of quantitative analysis of exercise thallium-201 myocardial emission computed tomography (ECT) was evaluated in coronary artery disease (CAD). The subjects consisted of 20 CAD patients and five normal controls. All CAD patients underwent coronary angiography. Tomographic thallium-201 myocardial imaging was performed with a rotating gamma camera, and long-axial and short-axial myocardial images of the left ventricle were reconstructed. The tomographic images were interpreted quantitatively using circumferential profile analysis. Based on features of regional myocardial thallium-201 kinetics, two types of abnormalities were studied: (1) diminished initial distribution (stress defect) and (2) slow washout of thallium-201, as evidenced by patients' initial thallium-201 uptake and 3-hour washout rate profiles which fell below the normal limits, respectively. Two diagnostic criteria including the stress defect and a combination of the stress defect and slow washout were used to detect coronary artery lesions of significance (>=75 % luminal narrowing). The ischemic volumes were also evaluated by quantitative analysis using thallium-201 ECT. The diagnostic accuracy of the stress defect criterion was 95 % for left anterior descending, 90 % for right, and 70 % for left circumflex coronary artery lesions. The combined criteria of the stress defect and slow washout increased detection sensitivity with a moderate loss of specificity for identifying individual coronary artery lesion. A relatively high diagnostic accuracy was obtained using the stress defect criterion for multiple vessel disease (75 %). Ischemic myocardial volume was significantly larger in triple vessel than in single vessel disease (p < 0.05) using the combined criteria. It was concluded that quantitative analysis of exercise thallium-201 myocardial ECT images proves useful for evaluating coronary artery lesions. (author)

The role of pharmacological stress Tc-99m sestamibi myocardial perfusion imaging in an Australian population

International Nuclear Information System (INIS)

Howarth, D.M.; Booker, J.A.; Tan, T.S.K.; Bellamy, G.R.; Hardy, D.B.; Howarth, G.C.

2003-01-01

This observational study was performed in order to assess the exercise-related incremental diagnostic accuracy of Tc-99m sestamibi myocardial perfusion imaging (MPI) in a hospital-based Australian population, and to assess the relative roles of exercise and pharmacological stress in myocardial perfusion imaging (MPI). Two hundred and eight adult patients who had both Tc-99m sestamibi myocardial perfusion imaging and coronary angiography within a median time of 16 weeks were studied. The diagnostic end-point was coronary artery lesions of ≥50% and >70% stenosis detected on angiography. Using receiver operating characteristic curve analysis, the overall diagnostic accuracy was calculated, as well as the comparative accuracies in patients who undertook various levels of exercise stress testing (n=130) and those who received pharmacological (dipyridamole) stress testing (n=78). The overall respective diagnostic accuracy of Tc-99m sestamibi MPI for the diagnosis of coronary artery disease (>70% stenosis) was 81% and 76% when using the diagnostic criterion of ≥50% stenosis. On direct comparison of perfusion defects with angiographic stenoses, the respective sensitivity and specificity for the detection of >70% stenosis in each coronary artery territory was 73% and 79%. Pharmacological MPI showed a significantly greater sensitivity for the detection of localised stenoses compared to the overall group who had exercise MPI performed. Consequently, exercise stress MPI showed significantly more false negative lesions compared to dipyridamole stress imaging (p<0.003). However, a large proportion of patients were unable to perform to adequate exercise levels in this patient sample. We conclude that Tc-99m sestamibi myocardial perfusion imaging is an accurate non-invasive test for the diagnosis of coronary artery disease. Where any doubt exists as to the patient's ability to achieve exercise levels at or above 85% of the predicted value for age and gender, pharmacological

Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

International Nuclear Information System (INIS)

Nasis, Arthur; Ko, Brian S.; Leung, Michael C.; Antonis, Paul R.; Wong, Dennis T.; Kyi, Leo; Cameron, James D.; Meredith, Ian T.; Seneviratne, Sujith K.; Nandurkar, Dee; Troupis, John M.

2013-01-01

To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD). Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard. All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 ± 7.4 mSv compared with 13.2 ± 2.2 mSv for SPECT-MPI (P < 0.001). Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI. (orig.)

Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

Energy Technology Data Exchange (ETDEWEB)

Nasis, Arthur; Ko, Brian S.; Leung, Michael C.; Antonis, Paul R.; Wong, Dennis T.; Kyi, Leo; Cameron, James D.; Meredith, Ian T.; Seneviratne, Sujith K. [Southern Health and Monash University, Monash Cardiovascular Research Centre, Monash Heart, Department of Medicine Monash Medical Centre (MMC), Melbourne (Australia); Nandurkar, Dee; Troupis, John M. [MMC, Southern Health, Department of Diagnostic Imaging, Melbourne (Australia)

2013-07-15

To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD). Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard. All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 {+-} 7.4 mSv compared with 13.2 {+-} 2.2 mSv for SPECT-MPI (P < 0.001). Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI. (orig.)

Heat stress protection in abnormally hot environments.

CSIR Research Space (South Africa)

Schutte, PC

1994-11-01

Full Text Available The present report presents the findings of SIMRAC project GAP 045 entitled ‘Heat stress protection in abnormally hot environments’. It is intended as a reference to develop guidelines which, in turn would assist mine management in establishing safe...

Implications of abnormal right ventricular thallium uptake in acute myocardial infarction

International Nuclear Information System (INIS)

Nestico, P.F.; Hakki, A.H.; Felsher, J.; Heo, J.; Iskandrian, A.S.

1986-01-01

The correlates of abnormal right ventricular (RV) thallium uptake were examined in 116 patients with documented acute myocardial infarction (AMI) who underwent predischarge thallium-201 scintigraphy at rest, radionuclide angiography and 24-hour ambulatory electrocardiography. The patients were separated into 2 groups: patients group 1 (n = 31) had increased RV thallium uptake and those in group 2 (n = 85) had no such uptake. The 2 groups were comparable in age, type and site of AMI, peak creatine kinase level, systolic blood pressure and heart rate. However, compared with group 2, group 1 had a lower mean left ventricular (LV) ejection fraction (33 +/- 15% vs 39 +/- 14%, p less than 0.05), higher prevalence of increased lung thallium uptake (45% vs 22%, p less than 0.02), more extensive LV perfusion defects (4.4 +/- 2.9 vs 3.0 +/- 3.0 segments, p less than 0.03) and more complex ventricular arrhythmias (55% vs 35%, p less than 0.05). At a mean follow-up of 6 months, 17 patients (8 in group 1 and 9 in group 2) died from cardiac causes. Actuarial life-table analysis showed that the survival rate was better in group 2 than in group 1 (Mantel-Cox statistics = 4.62, p = 0.03). Thus, patients with AMI and abnormal RV thallium uptake have worse LV function, more complex ventricular arrhythmias and worse prognosis

Future cardiac events in patients with ischemic ECG changes during adenosine infusion as a myocardial stress agent and normal cardiac scan.

Science.gov (United States)

Amer, Hamid; Niaz, Khalid; Hatazawa, Jun; Gasmelseed, Ahmed; Samiri, Hussain Al; Al Othman, Maram; Hammad, Mai Al

2017-11-01

We sought to determine the prognostic importance of adenosine-induced ischemic ECG changes in patients with normal single-photon emission computed tomography myocardial perfusion images (MPI). We carried out a retrospective analysis of 765 patients undergoing adenosine MPI between January 2013 and January 2015. Patients with baseline ECG abnormalities and/or abnormal scan were excluded. Overall, 67 (8.7%) patients had ischemic ECG changes during adenosine infusion in the form of ST depression of 1 mm or more. Of these, 29 [43% (3.8% of all patients)] had normal MPI (positive ECG group). An age-matched and sex-matched group of 108 patients with normal MPI without ECG changes served as control participants (negative ECG group). During a mean follow-up duration of 33.3±6.1 months, patients in the positive ECG group did not have significantly more adverse cardiac events than those in the negative ECG group. One (0.9%) patient in the negative ECG group had a nonfatal myocardial infarction (0.7% annual event rate after a negative MPI). Also in this group, two (1.8%) patients admitted with a diagnosis of CAD where they have been ruled out by angiography. A fourth case in this, in the negative ECG group, was admitted because of heart failure that proved to be secondary to a pulmonary cause and not CAD. A case only in the positive ECG group was admitted as a CAD that was ruled out by coronary angiography. Patients with normal myocardial perfusion scintigraphy in whom ST-segment depression develops during adenosine stress test appear to have no increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia.

Echocardiographic Wall Motion Abnormality in Posterior Myocardial Infarction: The Diagnostic Value of Posterior Leads

Directory of Open Access Journals (Sweden)

A Darehzereshki

2008-06-01

Full Text Available Background: For the purpose of ascertaining myocardial infarction (MI and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9 was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.Results: Of a total 79 patients enrolled, 48 (60.8% were men, and the mean age was 57.35±8.22 years. Smoking (54.4% and diabetes (48% were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1% had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

Impact of newly diagnosed abnormal glucose regulation on long-term prognosis in low risk patients with ST-elevation myocardial infarction: A follow-up study

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Abdelnoor Michael

2011-07-01

Full Text Available Abstract Background Patients with acute myocardial infarction and newly detected abnormal glucose regulation have been shown to have a less favourable prognosis compared to patients with normal glucose regulation. The importance and timing of oral glucose tolerance testing (OGTT in patients with acute myocardial infarction without known diabetes is uncertain. The aim of the present study was to evaluate the impact of abnormal glucose regulation classified by an OGTT in-hospital and at three-month follow-up on clinical outcome in patients with acute ST elevation myocardial infarction (STEMI without known diabetes. Methods Patients (n = 224, age 58 years with a primary percutanous coronary intervention (PCI treated STEMI were followed for clinical events (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, and stroke. The patients were classified by a standardised 75 g OGTT at two time points, first, at a median time of 16.5 hours after hospital admission, then at three-month follow-up. Based on the OGTT results, the patients were categorised according to the WHO criteria and the term abnormal glucose regulation was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes. Results The number of patients diagnosed with abnormal glucose regulation in-hospital and at three-month was 105 (47% and 50 (25%, respectively. During the follow up time of (median 33 (27, 39 months, 58 (25.9% patients experienced a new clinical event. There were six deaths, 15 non-fatal re-infarction, 33 recurrent ischemia, and four strokes. Kaplan-Meier analysis of survival free of composite end-points showed similar results in patients with abnormal and normal glucose regulation, both when classified in-hospital (p = 0.4 and re-classified three months later (p = 0.3. Conclusions Patients with a primary PCI treated STEMI, without previously known diabetes, appear to have an excellent

Effect of streptozotocin-induced diabetes on myocardial blood flow reserve assessed by myocardial contrast echocardiography in rats

Directory of Open Access Journals (Sweden)

Weytjens Caroline

2008-09-01

Full Text Available Abstract The role of structural and functional abnormalities of small vessels in diabetes cardiomyopathy remains unclear. Myocardial contrast echocardiography allows the quantification of myocardial blood flow at rest and during dipyridamole infusion. The aim of the study was to determine the myocardial blood flow reserve in normal rats compared with Streptozotocin-induced diabetic rats using contrast echocardiography. Methods We prospectively studied 40 Wistar rats. Diabetes was induced by intravenous streptozotocin in 20 rats. All rats underwent baseline and stress (dipyridamole: 20 mg/kg high power intermittent imaging in short axis view under anaesthesia baseline and after six months. Myocardial blood flow was determined and compared at rest and after dipyridamole in both populations. The myocardial blood flow reserve was calculated and compared in the 2 groups. Parameters of left ventricular function were determined from the M-mode tracings and histological examination was performed in all rats at the end of the study. Results At six months, myocardial blood flow reserve was significantly lower in diabetic rats compared to controls (3.09 ± 0.98 vs. 1.28 ± 0.67 ml min-1 g-1; p Conclusion In this animal study, diabetes induced a functional alteration of the coronary microcirculation, as demonstrated by contrast echocardiography, a decrease in capillary density and of the cardiac systolic function. These findings may offer new insights into the underlying mechanisms of diabetes cardiomyopathy.

Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry.

Science.gov (United States)

Dorbala, Sharmila; Di Carli, Marcelo F; Beanlands, Rob S; Merhige, Michael E; Williams, Brent A; Veledar, Emir; Chow, Benjamin J W; Min, James K; Pencina, Michael J; Berman, Daniel S; Shaw, Leslee J

2013-01-15

The primary objective of this multicenter registry was to study the prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) and the improved classification of risk in a large cohort of patients with suspected or known coronary artery disease (CAD). Limited prognostic data are available for MPI with PET. A total of 7,061 patients from 4 centers underwent a clinically indicated rest/stress rubidium-82 PET MPI, with a median follow-up of 2.2 years. The primary outcome of this study was cardiac death (n = 169), and the secondary outcome was all-cause death (n = 570). Net reclassification improvement (NRI) and integrated discrimination analyses were performed. Risk-adjusted hazard of cardiac death increased with each 10% myocardium abnormal with mildly, moderately, or severely abnormal stress PET (hazard ratio [HR]: 2.3 [95% CI: 1.4 to 3.8; p = 0.001], HR: 4.2 [95% CI: 2.3 to 7.5; p statistic 0.805 [95% CI: 0.772 to 0.838] to 0.839 [95% CI: 0.809 to 0.869]) and risk reclassification for cardiac death (NRI 0.116 [95% CI: 0.021 to 0.210]), with smaller improvements in risk assessment for all-cause death. In patients with known or suspected CAD, the extent and severity of ischemia and scar on PET MPI provided powerful and incremental risk estimates of cardiac death and all-cause death compared with traditional coronary risk factors. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

High-intensity training reduces intermittent hypoxia-induced ER stress and myocardial infarct size.

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Bourdier, Guillaume; Flore, Patrice; Sanchez, Hervé; Pepin, Jean-Louis; Belaidi, Elise; Arnaud, Claire

2016-01-15

Chronic intermittent hypoxia (IH) is described as the major detrimental factor leading to cardiovascular morbimortality in obstructive sleep apnea (OSA) patients. OSA patients exhibit increased infarct size after a myocardial event, and previous animal studies have shown that chronic IH could be the main mechanism. Endoplasmic reticulum (ER) stress plays a major role in the pathophysiology of cardiovascular disease. High-intensity training (HIT) exerts beneficial effects on the cardiovascular system. Thus, we hypothesized that HIT could prevent IH-induced ER stress and the increase in infarct size. Male Wistar rats were exposed to 21 days of IH (21-5% fraction of inspired O2, 60-s cycle, 8 h/day) or normoxia. After 1 wk of IH alone, rats were submitted daily to both IH and HIT (2 × 24 min, 15-30m/min). Rat hearts were either rapidly frozen to evaluate ER stress by Western blot analysis or submitted to an ischemia-reperfusion protocol ex vivo (30 min of global ischemia/120 min of reperfusion). IH induced cardiac proapoptotic ER stress, characterized by increased expression of glucose-regulated protein kinase 78, phosphorylated protein kinase-like ER kinase, activating transcription factor 4, and C/EBP homologous protein. IH-induced myocardial apoptosis was confirmed by increased expression of cleaved caspase-3. These IH-associated proapoptotic alterations were associated with a significant increase in infarct size (35.4 ± 3.2% vs. 22.7 ± 1.7% of ventricles in IH + sedenary and normoxia + sedentary groups, respectively, P < 0.05). HIT prevented both the IH-induced proapoptotic ER stress and increased myocardial infarct size (28.8 ± 3.9% and 21.0 ± 5.1% in IH + HIT and normoxia + HIT groups, respectively, P = 0.28). In conclusion, these findings suggest that HIT could represent a preventive strategy to limit IH-induced myocardial ischemia-reperfusion damages in OSA patients. Copyright © 2016 the American Physiological Society.

Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting.

Science.gov (United States)

Singh, Amitoj; Agrawal, Sahil; Gargya, Sanchita; Saluja, Sabir; Kumar, Akshat; Kumar, Abhishek; Kalra, Kartik; Thind, Munveer; Saluja, Sajeev; Stone, Lauren E; Ali, Farhan; Duarte-Chavez, Rodrigo; Marchionni, Christine; Sholevar, Farhad; Shirani, Jamshid; Nanda, Sudip

2017-01-01

Post traumatic stress disorder is a psychiatric disease that is usually precipitated by life threatening stressors. Myocardial infarction, especially in the young can count as one such event. The development of post traumatic stress after a coronary event not only adversely effects psychiatric health, but leads to increased cardiovascular morbidity and mortality. There is increasing evidence that like major depression, post traumatic stress disorder is also a strong coronary risk factor. Early diagnosis and treatment of this disease in patients with acute manifestations of coronary artery disease can improve patient outcomes.

Prevalence of symptomatic and silent stress-induced perfusion defects in diabetic patients with suspected coronary artery disease referred for myocardial perfusion scintigraphy

International Nuclear Information System (INIS)

Prior, John O.; Calcagni, Maria-Lucia; Bischof Delaloye, Angelika; Monbaron, David; Ruiz, Juan; Koehli, Melanie

2005-01-01

Silent myocardial ischaemia - as evaluated by stress-induced perfusion defects on myocardial perfusion scintigraphy (MPS) in patients without a history of chest pain - is frequent in diabetes and is associated with increased rates of cardiovascular events. Its prevalence has been determined in asymptomatic diabetic patients, but remains largely unknown in diabetic patients with suspected coronary artery disease (CAD) in the clinical setting. In this study we therefore sought (a) to determine the prevalence of symptomatic and silent perfusion defects in diabetic patients with suspected CAD and (b) to characterise the eventual predictors of abnormal perfusion. The patient population comprised 133 consecutive diabetic patients with suspected CAD who had been referred for MPS. Studies were performed with exercise (41%) or pharmacological stress testing (1-day protocol, 99m Tc-sestamibi, 201 Tl or both). We used semi-quantitative analysis (20-segment polar maps) to derive the summed stress score (SSS) and the summed difference score (SDS). Abnormal MPS (SSS≥4) was observed in 49 (37%) patients (SSS=4.9±8.4, SDS=2.4±4.7), reversible perfusion defects (SDS≥2) in 40 (30%) patients [SSS=13.3±10.9; SDS=8.0±5.6; 20% moderate to severe (SDS>4), 7% multivessel] and fixed defects in 21 (16%) patients. Results were comparable between patients with and patients without a history of chest pain. Of 75 patients without a history of chest pain, 23 (31%, 95% CI=21-42%) presented reversible defects (SSS=13.9±11.3; SDS=7.4±1.2), indicative of silent ischaemia. Reversible defects were associated with inducible ST segment depression during MPS stress (odds ratio (OR)=3.2, p<0.01). Fixed defects were associated with erectile dysfunction in males (OR=3.7, p=0.02) and lower aspirin use (OR=0.25, p=0.02). Silent stress-induced perfusion defects occurred in 31% of the patients, a rate similar to that in patients with a history of chest pain. MPS could identify these patients with a

Variation in heart rate influences the assessment of transient ischemic dilation in myocardial perfusion scintigraphy

International Nuclear Information System (INIS)

Leslie, William D; Levin, Daniel P; Demeter, Sandor J

2007-01-01

Transient arrhythmias can affect transient ischemic dilation (TID) ratios. This study was initiated to evaluate the frequency and effect of normal heart rate change on TID measures in routine clinical practice. Consecutive patients undergoing stress/rest sestamibi gated myocardial perfusion scintigraphy were studied (N = 407). Heart rate at the time of stress and rest imaging were recorded. TID ratios were analyzed in relation to absolute change in heart rate (stress minus rest) for subjects with normal perfusion and systolic function (Group 1, N = 169) and those with abnormalities in perfusion and/or function (Group 2, N = 238). In Group 1, mean TID ratio was inversely correlated with the change in heart rate (r = -0.47, P < 0.0001). For every increase of 10 BPM in heart rate change, the TID ratio decreased by approximately 0.06 (95% confidence interval 0.04–0.07). In Group 2, multiple linear regression demonstrated that the change in heart rate (beta = -0.25, P < 0.0001) and the summed difference score (beta = 0.36, P < 0.0001) were independent predictors of the TID ratio. Normal variation in heart rate between the stress and rest components of myocardial perfusion scans is common and can influence TID ratios in patients with normal and abnormal cardiac scans

Technetium-99m-pyrophosphate myocardial imaging in unstable angina

International Nuclear Information System (INIS)

Willerson, J.T.; Parkey, R.W.; Lewis, S.E.; Buja, L.M.; Bonte, F.J.

1980-01-01

The authors have found that approximately one third of patients with the syndrome of unstable angina pectoris have abnormal 99mTc-pyrophosphate myocardial scintigrams even in the absence of abnormal enzymes and electrocardiographic confirmation of the presence of acute myocardial necrosis. Thus, 99mTc-pyrophosphate myocardial imaging technique appears to represent a sensitive means to detect acute multicellular injury associated with the clinical syndrome of unstable angina pectoris even when cardiac enzymes are normal and the electrocardiogram does not definitively document the presence of acute myocardial necrosis. (Auth.)

Single-photon emission computed tomography myocardial perfusion imaging-assessed stress perfusion defect severity is associated with mortality independent of ethnicity in an Asian population.

Science.gov (United States)

Chin, Chee Tang; Gao, Fei; Keng, Felix Y J; Shah, Bimal R; Koh, Angela S; Tan, Ru San; Chua, Terrance S J

2014-12-01

Ischemic heart disease is growing by epidemic proportions in Asia. Among patients in Western populations with similar myocardial perfusion imaging (MPI) ischemia severity, ethnicity is independently associated with mortality. We aimed to determine the differential prognostic value of MPI abnormality severity among three major Asian ethnic groups. From 16,921 consecutive patients, we used summed stress score to define increasing abnormal scan severity groups (minimal, mild, moderate, and severe) among Chinese, Indian, and Malay patients. We determined mortality from the national death registry. Using multivariable Cox regression models, we examined the association between ethnicity and mortality. Chinese patients were older than Indians or Malays. Annual all-cause death rates increased with increasing abnormal scan severity in all three ethnicities. After adjustment, ethnicity was not associated with mortality. With Chinese as the reference group, adjusted hazard ratio and 95% CI for Malays and Indians were 1.29 (0.95-1.77) and 1.06 (0.74-1.50) in the minimally abnormal scan group, and 1.20 (0.75-1.91) and 0.82 (0.47-1.45) in the severely abnormal scan group, respectively. Mortality risk is related to the severity of scan abnormality and is independent of ethnicity in Asians. Our findings emphasize the continued utility of MPI in guiding risk stratification in Asia.

Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

OpenAIRE

Cabeda, Est?van Vieira; Falc?o, Andr?a Maria Gomes; Soares Jr., Jos?; Rochitte, Carlos Eduardo; Nomura, C?sar Higa; ?vila, Luiz Francisco Rodrigues; Parga, Jos? Rodrigues

2015-01-01

Abstract Background: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and comp...

Clinical implications of diffuse slow washout of thallium-201 in exercise stress myocardial SPECT

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Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Honda, Minoru (Sumitomo Hospital, Osaka (Japan))

1991-07-01

Clinical implications of diffuse slow washout of thallium-201 (DSWO) in exercise-redistribution myocardial SPECT were studied. Thallium-201 washout rate was calculated by Bull's-eye method. DSWO was defined as having abnormal thallium-201 washout rate (<30% per 3 hours) in more than two thirds of each coronary artery (CA) area. Of 974 patients whose exercise heart rate exceeded 120/min, 51 (5.2%) showed DSWO and coronary angiography was performed in 43. Twenty-three patients (53%) showed triple vessel disease (3VD), 8 (19%) showed single or double vessel disease (1VD/2VD) and 12 (28%) showed normal CA. Patients with normal CA consisted of 6 patients with hypertrophic cardiomyopathy (HCM), 5 with hypertension (HT) and one with electrocardiographic abnormality only. The cause of DSWO were assessed from the history of effort angina (EA) and congestive heart failure (CHF), delayed fill-in of the perfusion defect and the ratio of lung to heart thallium-201 activity (L/M) at exercise as an indicator of the left ventricular (LV) function. High prevalence of EA (74%), high incidence of scintigraphic delayed fill-in (83%) and normal L/M suggested diffuse LV ischemia as the cause of DSWO in 3VD. On the other hand in patients with 1VD/2VD, LV dysfunction at exercise was considered as the cause of DSWO because of low prevalence of EA (13%) and scintigraphic delayed fill-in (13%)(p<0.01, p<0.005 each vs 3VD), and high L/M (p<0.001 vs 3VD) and high prevalence of CHF (38%, NS). In patients with HCM LV ischemia at small vessel levels was assumed as the cause of DSWO from the high incidence of EA (83%) and delayed fill-in (50%), low L/M and normal CA. In cases of HTLV dysfunction and/or LV ischemia at the small vessel levels were considered as the cause of DSWO. Thus, it was concluded that DSWO is a noteworthy finding in exercise stress myocardial imaging. (author).

Application of the newly developed Japanese adenosine normal database for adenosine stress myocardial scintigraphy.

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Harata, Shingo; Isobe, Satoshi; Morishima, Itsuro; Suzuki, Susumu; Tsuboi, Hideyuki; Sone, Takahito; Ishii, Hideki; Murohara, Toyoaki

2015-10-01

The currently available Japanese normal database (NDB) in stress myocardial perfusion scintigraphy recommended by the Japanese Society of Nuclear Medicine (JSNM-NDB) is created based on the data from exercise tests. The newly developed adenosine normal database (ADS-NDB) remains to be validated for patients undergoing adenosine stress test. We tested whether the diagnostic accuracy of adenosine stress test is improved by the use of ADS-NDB (Kanazawa University). Of 233 consecutive patients undergoing (99m)Tc-MIBI adenosine stress test, 112 patients were tested. The stress/rest myocardial (99m)Tc-MIBI single-photon emission computed tomography (SPECT) images were analyzed by AutoQUANT 7.2 with both ADS-NDB and JSNM-NDB. The summed stress score (SSS) and summed difference score (SDS) were calculated. The agreements of the post-stress defect severity between ADS-NDB and JSNM-NDB were assessed using a weighted kappa statistic. In all patients, mean SSSs of all, right coronary artery (RCA), left anterior descending (LAD), and left circumflex (LCx) territories were significantly lower with ADS-NDB than those with JSNM-NDB. Mean SDSs in all, RCA, and LAD territories were significantly lower with ADS-NDB than those with JSNM-NDB. In 28 patients with significant coronary stenosis, the mean SSS in the RCA territory was significantly lower with ADS-NDB than that with JSNM-NDB. In 84 patients without ischemia, both mean SSSs and SDSs in all, RCA, LAD, and LCx territories were significantly lower with ADS-NDB than those with JSNM-NDB. Weighted kappa values of all patients, patients with significant stenosis, and patients without ischemia were 0.89, 0.83, and 0.92, respectively. Differences were observed between results from ADS-NDB and JSNM-NDB. The diagnostic accuracy of adenosine stress myocardial perfusion scintigraphy may be improved by reducing false-positive results.

The expression of myocardial injury in cold induced myocardial imaging and echocardiography of systematic scleroderma

International Nuclear Information System (INIS)

Liang Jiugen; Zhu Xiaojun; Jiang Ningyi; Chen Shaoxiong

1999-01-01

The study was performed with cold-induced 99m Tc(MIBI) myocardial imaging (MI) in 23 patients with systematic scleroderma. The left ventricular function and wall motion were also observed by dimensional echocardiography (UCG). 14 patients had myocardial perfusion abnormalities visualized by MI, including 5 cases with fixed defects of 9 segments, 3 cases with reversible defects of 6 segments and 6 cases with both fixed and reversible one of 14 segments. The positive rate in myocardial imaging had no significant differences between patients with and without Raynaud's phenomenon (0.5>P>0.25). Compared with baseline, the ejection fraction, stroke volume, cardiac output were significantly decreased during cold-induced in patients with abnormal myocardial scintigraphy (P<0.05), and had significant difference compared with normal group (P<0.05). 4 cases with cold-induced reversible perfusion defects had anatomically correlated regional ventricular hypokinesia in UCG

A clinical study of gated simultaneous rest 201Tl/stress 99Tcm-sestamibi dual isotope myocardial perfusion imaging

International Nuclear Information System (INIS)

Tang Anwu; Qiao Shuixian; Luo Yaowu; Liang Xiaolin

2002-01-01

Objective: To investigate a modified gated radionuclide myocardial tomography in methodology for raising the sensitivity and efficiency of detecting myocardial ischemia. Methods: One hundred and three patients were involved and divided into two groups: coronary artery disease (CAD) patient 37, non-CAD patient 66. 201 Tl 111 MBq was injected intravenously 5 min before stress, the patient exercised with ergometer following the modified Bruce protocol, and was injected 99 Tc m -sestamibi at the peak of stress. 45 min later, the simultaneous dual energy peak gated acquisition was then performed. Stress ( 99 Tc m -sestamibi) and rest ( 201 Tl) images were reconstructed. Results: Positive findings were seen in 35/37 (94.6%) in CAD group and 7/66 (10.6%) in non-CAD, respectively; LVEF, EDV and ESV of two groups were (52.33+-16.26)%, (70.45+-28.12) mL, (33.35 +- 18.86) mL and (61.76 +- 9.38)%, (60.45 +- 18.18) mL, (23.30 +- 11.09) mL, respectively. Conclusion: The simultaneous stress ( 99 Tc m -sestamibi) and rest ( 201 Tl) gated myocardial imaging is an efficient and practical protocol for the study of myocardial perfusion and the diagnosis of ischemia

Usefulness of 123I-BMIPP myocardial imaging in patients with stable effort angina and unstable angina

International Nuclear Information System (INIS)

Inoue, Seiji; Kobayashi, Hideki; Oka, Toshiaki; Kawaguchi, Masao; Momose, Mitsuru; Kasanuki, Hiroshi; Kusakabe, Kiyoko; Hosoda, Saichi

1995-01-01

We evaluated the clinical significance of myocardial imaging using 123 I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy in patients with stable effort angina pectoris (SAP) and unstable angina pectoris (UAP). Thirty-three patients with SAP were studied using rest BMIPP and stress 201 TlCl (Tl) myocardial scintigraphy, and 13 patients with worsening effort type of UAP were also examined using both rest BMIPP and Tl scintigraphy. We compared those BMIPP findings with myocardial perfusion images obtained with Tl and the regional wall motion determined by left ventriculography. In 45% of 282 segments of myocardial ischemia of SAP, the degree of myocardial uptake of BMIPP was concordant with that of stress Tl and the defect score of Tl was higher than that of BMIPP. On the other hand, in 32% of 62 segments of ischemia of UAP, the degree of myocardial BMIPP and Tl uptake was concordant and BMIPP defect score was higher than Tl score. In SAP, the decrease in regional wall motion agreed better with the decrease in myocardial uptake of BMIPP than that of Tl. These results suggest that myocardial ischemic regions decreased BMIPP uptake show the disturbance of fatty acid metabolism and lead to abnormal wall motions. Such ischemic regions may be clinically severe state in patients with angina pectoris. (author)

Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE

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Mara Graziele Maciel Silveira

2015-05-01

Full Text Available Background: Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2 the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group. Objective: To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences. Methods: 4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3% and non-obese (n = 3,105; 76.6%. Results: There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67 and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001, diabetis mellitus (15.2% vs. 10.9%; p < 0.0001, dyslipidemia (59.5% vs 51.9%; p < 0.0001, family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023 and physical inactivity (71.4% vs. 52.9%, p < 0.0001. The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001, left atrium (3.97 vs. 3.72 cm; p < 0.0001 and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001. Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41. In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension. Conclusion: Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.

"MENTAL STRAIN, MORE IMPORTANT THAN STRESSFUL LIFE EVENTS IN MYOCARDIAL INFARCTION"

OpenAIRE

M. Moosavi; M. Eslami; O. Sheikh Bagloo B. Birashk

2004-01-01

Stressful life events may play an important role in coronary heart disease and sudden cardiac death. This study was performed to compare the frequency of stressful events and mental strain in patients with acute myocardial infarction (MI) and normal population. A case-control study was performed on 50 survivors of MI and 50 controls with no evidence of cardiovascular disease, matched by age, gender, education, race, and number of family members. A questionnaire was used to determine the numbe...

Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion.

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Korosoglou, Grigorios; Elhmidi, Yacine; Steen, Henning; Schellberg, Dieter; Riedle, Nina; Ahrens, Johannes; Lehrke, Stephanie; Merten, Constanze; Lossnitzer, Dirk; Radeleff, Jannis; Zugck, Christian; Giannitsis, Evangelos; Katus, Hugo A

2010-10-05

This study sought to determine the prognostic value of wall motion and perfusion assessment during high-dose dobutamine stress (DS) cardiac magnetic resonance imaging (MRI) in a large patient cohort. DS-MRI offers the possibility to integrate myocardial perfusion and wall motion analysis in a single examination for the detection of coronary artery disease (CAD). A total of 1,493 consecutive patients with suspected or known CAD underwent DS-MRI, using a standard protocol in a 1.5-T magnetic resonance scanner. Wall motion and perfusion were assessed at baseline and during stress, and outcome data including cardiac death, nonfatal myocardial infarction ("hard events"), and "late" revascularization performed >90 days after the MR scans were collected during a 2 ± 1 year follow-up period. Fifty-three hard events, including 14 cardiac deaths and 39 nonfatal infarctions, occurred during the follow-up period, whereas 85 patients underwent "late" revascularization. Using multivariable regression analysis, an abnormal result for wall motion or perfusion during stress yielded the strongest independent prognostic value for both hard events and late revascularization, clearly surpassing that of clinical and baseline magnetic resonance parameters (for wall motion: adjusted hazard ratio [HR] of 5.9 [95% confidence interval (CI): 2.5 to 13.6] for hard events and of 3.1 [95% CI: 1.7 to 5.6] for late revascularization, and for perfusion: adjusted HR of 5.4 [95% CI: 2.3 to 12.9] for hard events and of 6.2 [95% CI: 3.3 to 11.3] for late revascularization, p < 0.001 for all). DS-MRI can accurately identify patients who are at increased risk for cardiac death and myocardial infarction, separating them from those with normal findings, who have very low risk for future cardiac events. (Prognostic Value of High Dose Dobutamine Stress Magnetic Resonance Imaging; NCT00837005). Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effect of spinal cord stimulation on myocardial perfusion reserve in patients with refractory angina pectoris.

Science.gov (United States)

Saraste, Antti; Ukkonen, Heikki; Varis, Antti; Vasankari, Tuija; Tunturi, Satu; Taittonen, Markku; Rautakorpi, Pirkka; Luotolahti, Matti; Airaksinen, K E Juhani; Knuuti, Juhani

2015-04-01

Epidural spinal cord stimulation (SCS) provides symptom relief in refractory angina pectoris, but its mechanism of action remains incompletely understood. We studied effects of short-term SCS therapy on myocardial ischaemia tolerance, myocardial perfusion reserve (MPR), and endothelium-mediated vasodilatation induced by cold pressor test (CPT) in patients with refractory angina pectoris. We prospectively recruited 18 patients with refractory angina pectoris and studied them after implantation of SCS device at baseline before starting the therapy and after 3 weeks of continuous SCS therapy. Myocardial ischaemia was evaluated by dobutamine stress echocardiography. Global and regional myocardial blood flow (MBF) were measured using positron emission tomography and (15)O-water at rest, during adenosine stress, and in response to CPT. Systemic haemodynamics were comparable before and after 3 weeks of SCS at rest, during adenosine stress and during CPT. Appearance of angina pectoris induced by dobutamine stress was delayed after SCS therapy. Global MPR increased (P = 0.02) from 1.7 ± 0.6 at baseline to 2.0 ± 0.6 after 3-week SCS therapy. This was associated with a significant reduction in global MBF at rest and increase in MBF induced by adenosine in the ischaemic regions. Global MBF response to CPT was improved after SCS (0.27 ± 0.20 vs. 0.40 ± 0.15, P = 0.03). Short-term SCS therapy improved myocardial ischaemia tolerance, absolute MPR, and endothelium-mediated vasomotor function in refractory angina pectoris, indicating that this therapy can alleviate myocardial perfusion abnormalities in advanced CAD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Myocardial uptake and clearance of thallium-201 in normal subjects: comparison of dipyridamole-induced hyperemia with exercise stress

International Nuclear Information System (INIS)

Ruddy, T.D.; Gill, J.B.; Finkelstein, D.M.; Strauss, H.W.; McKusick, K.A.; Okada, R.D.; Boucher, C.A.

1987-01-01

Thallium-201 uptake and clearance after dipyridamole infusion may differ from that after exercise stress because the hemodynamic effects of these two interventions are different. In this study of normal volunteers, thallium kinetics after dipyridamole (n = 13) were determined from three serial image sets (early, intermediate and delayed) and from serial blood samples and compared with thallium kinetics after exercise (n = 15). Absolute myocardial thallium uptake was greater after dipyridamole compared with exercise (p less than 0.0001), although the relative myocardial distribution was similar. The myocardial clearance (%/h) of thallium was slower after dipyridamole than it was after exercise. Comparing dipyridamole and exercise, the differences in clearance were large from the early to the intermediate image (anterior, -11 +/- 17 versus 24 +/- 5, p = 0.0005; 50 degrees left anterior oblique, -7 +/- 11 versus 15 +/- 8, p = 0.004; 70 degrees left anterior oblique, 3 +/- 9 versus 21 +/- 6, p = 0.001). In contrast, the differences in clearance were small from the intermediate to the delayed image (anterior, 15 +/- 4 versus 20 +/- 2, p = 0.025; 50 degrees left anterior oblique, 15 +/- 4 versus 19 +/- 3, p = 0.13; 70 degrees left anterior oblique, 15 +/- 3 versus 18 +/- 2, p = 0.047). Thallium uptake and clearance in the liver, splanchnic region and spleen were greater after dipyridamole (p less than 0.001). Blood thallium levels were greater after dipyridamole (p less than 0.05) and cleared more slowly (p = 0.07). Thus, myocardial thallium-201 uptake and clearance after dipyridamole infusion differ from thallium kinetics after exercise. This difference is, in part, related to associated differences in extracardiac and blood kinetics. Diagnostic criteria for the detection of abnormal thallium-201 clearance must be specific for the type of intervention

Tomoscintigraphic assessment of myocardial metabolic heterogenity

International Nuclear Information System (INIS)

Roesler, H.; Hess, T.; Weiss, M.; Noelpp, U.; Mueller, G.; Hoeflin, F.; Kinser, J.

1983-01-01

I-123-omega-heptadecanoic acid (HDA) was evaluated for myocardial scanning in 59 healthy volunteers and 133 patients, using a 7-pinhole collimator. Early (uptake) and late (retention) images were compared visually. Regional HDA elimination was also followed semiquantitatively based on the calculation of a retention-over-uptake ratio, R(phi), derived from the maximal counts/pixel in 60 midventricular slice sectors. The healthy heart concentrated HDA homogeneously in all segments with no difference between early and late images. The minimal R(phi), taken as representative of that myocardium with the best function, was unchanged after maximal ergometer stress and with dipyramidole-induced hyperperfusion. A circumscribed decreased HDA uptake is the clear-cut criterion for an abnormal finding. HDA tomography of the myocardium had an 86% sensitivity for myocardial infarcts (MIs) up to 4 wk old, and 83% for myocardial scars (MSs). Comparing early and late tomograms, we find a cool-warm sequence more often with acute and subacute MIs. A cool-cool or a cold-cold sequence dominated with MSs. HDA tomoscintigraphy cannot replace TI-201 for the evaluation of regional coronary reserve in coronary heart disease

Inflammation and vascular responses to acute mental stress : implications for the triggering of myocardial infarction

NARCIS (Netherlands)

Paine, N.J.; Bosch, J.A.; Veldhuijzen Van Zanten, J.J.C.S.

2012-01-01

There is evidence that mental stress can trigger myocardial infarction. Even though the underlying mechanisms remain to be determined, both inflammation and vascular responses to mental stress have been implicated as contributing factors. This review explores the effects of inflammation on the

Usefulness of combination post-stress dysfunction and perfusion imaging in technetium-99m-tetrofosmin myocardial scintigraphy

International Nuclear Information System (INIS)

Yamazaki, Yoko; Imai, Kamon; Konaka, Ryohei; Nakajima, Takatomo; Goto, Sayaka; Horie, Toshinobu; Saito, Satoshi; Ozawa, Yukio; Kanmatsuse, Katsuo

2001-01-01

Myocardial perfusion imaging has lower sensitivity for the diagnosis of coronary artery disease in patients with three-vessel disease. The presence of post-stress dysfunction of the left ventricle, evaluated by electrocardiography (ECG) gated single photon emission computed tomography (SPECT) with a quantitative gated SPECT program, was investigated in patients with coronary artery disease, and also whether combining post-stress dysfunction and myocardial perfusion imaging improved the diagnosis of coronary artery disease. ECG gated technetium-99m-tetrofosmin SPECT was performed using a one day, stress and rest, protocol in 139 patients. SPECT and coronary angiography were performed within 1 month. The coronary artery disease group consisted of 89 patients: 43 with one-vessel disease (1VD), 28 with two-vessel disease (2VD), and 18 with three-vessel disease (3VD). The group with zero-vessel disease (0VD) consisted of 50 patients. According to post-stress and rest ejection fraction (EF) and end-systolic volume (ESV), post-stress dysfunction is defined as follows: rest EF - post-stress EF≥5% and post-stress ESV - rest ESV≥5ml. In the coronary artery disease group, post-stress ESV was larger than rest ESV (37.8±26.4, 34.0±24.2 ml, p<0.001), and post-stress EF was lower than rest EF (61.5±11.1%, 64.2±10.8%, p<0.001). In the 0VD group, ESV and EF were the same for post-stress and rest (25.7±20.8, 26.2±21.6 ml, NS; 70.4±9.5%, 70.0±9.6%, NS). Post-stress dysfunction was 6.0% in the 0VD group and 30.3% in the coronary artery disease group (p<0.001). Furthermore, post-stress dysfunction in the 2VD (35.7%) and 3VD (38.9%) groups was higher than that in the 0VD group (p<0.01, p<0.01). Sensitivity of coronary artery disease diagnosis by myocardial perfusion imaging was 75%. The combination of post-stress dysfunction and myocardial perfusion imaging improved sensitivity from 75% to 82% (p<0.05), but reduced the specificity from 92% to 86% (p=0.08). Post-stress

Myocardial involvement in diabetic patients evaluated by exercise thallium-201 scintigraphy and cardiac catheterization

International Nuclear Information System (INIS)

Mizuno, Sumio; Genda, Akira; Nakayama, Akira; Igarashi, Yutaka; Takeda, Ryoyu

1985-01-01

To evaluate myocardial involvement in diabetes mellitus, we studied 39 patients with negative double-Master's test and without hypertension by exercise thallium-201 (Tl-201) myocardial scintigraphy using a bicycle ergometer. Among the 39 patients, 12 (30.8 %) showed filling defects in the scintigrams (positive cases), including eight with stress-induced defects and four with fixed defects. The positive cases had higher scores of diabetic complications (3.6 +- 2.4 vs 2.1 +- 1.8; p < 0.05) and longer durations of diabetes as compared with those of the negative cases. The frequency of insulin therapy was also greater in the positive cases. Eleven patients (5 positive and 6 negative cases) who underwent cardiac catheterization had no significant stenotic lesions of their coronary arteries. However, all of the positive cases showed abnormal wall motion, mainly hypokinesis, by left ventriculography (LVG). The abnormalities of the LVG corresponded to the findings of the scintigrams (i.e. filling defects and decrease in washout ratios by circumferential profile analysis). These results suggest that in some diabetics myocardial involvement exists in the early stage without overt cardiac disease and exercise Tl-201 scintigraphy is useful in detecting pre-clinical cardiomyopathy. Cardiomyopathy in diabetics seems to be due to disturbances of the myocardial microcirculation. (author)

Usefulness of Myocardial Annular Velocity Change During Mental Stress to Predict Cardiovascular Outcome in Patients With Coronary Artery Disease (From the Responses of Mental Stress-Induced Myocardial Ischemia to Escitalopram Treatment Trial).

Science.gov (United States)

Alenezi, Fawaz; Brummett, Beverly H; Boyle, Stephen H; Samad, Zainab; Babyak, Michael A; Alzaeim, Nabil; Wilson, Jennifer; Romano, Minna M D; Sun, Julia L; Ersboll, Mads; O'Connor, Christopher M; Velazquez, Eric J; Jiang, Wei

2017-11-01

Mental stress-induced myocardial ischemia is common and a prognostic factor of adverse cardiovascular outcomes in patients with coronary artery disease (CAD). The present study aimed at examining associations between mental stress-induced myocardial annular velocity (MAV) and cardiovascular outcome in patients with CAD. MAV, specifically, diastolic early (e'), diastolic late (a'), and systolic (s') velocities were obtained at rest and during mental stress testing in 224 patients with clinically stable CAD. Using Cox regression models, age, sex, and baseline-adjusted mental stress-induced MAV measures were examined as predictors of a priori defined composite event term that comprised all-cause mortality and/or nonfatal cardiovascular events, resulting in an unplanned hospitalization (major adverse cardiovascular events [MACE]). Median follow-up was 4 years. The sample was predominantly male, Caucasian with New York Heart Association functional class I and a mean age of 63 ± 10.2 years. MS-induced changes in e' (hazard ratio [HR] = .73) and s' (HR = .73) were significant (p Mental stress-induced MAV changes independently predict an adverse cardiovascular outcome in patients with stable CAD. Copyright © 2017 Elsevier Inc. All rights reserved.

Value of dipyridamole stress 201Tl myocardial SPECT in detecting dysfunction of coronary microcirculation

International Nuclear Information System (INIS)

Lou Ying; Jiang Jinqi; Xie Wenhui; Yuan Fang; Wang Tong; Yang Yiqing

2012-01-01

Objective: To evaluate the value of dipyridamole stress 201 Tl myocardial SPECT in detecting dysfunction of coronary microcirculation. Methods: Forty-eight patients diagnosed with cardiac syndrome X underwent dipyridamole stress 201 Tl myocardial SPECT. Dipyridamole (0.56 mg/kg) was intravenously injected over 4 min followed by 201 Tl (111 MBq) injection at 2 min after dipyridamole administration. Image was acquired at 10 min and 240 min post-injection and co-analyzed by over two experienced doctors in nuclear medicine after three-dimensional reconstruction. The patients with 'reverse redistribution' underwent repeated dipyridamole stress 201 Tl SPECT after medical therapy for 2 weeks. The clinical symptoms and results of the treadmill exercise test pre-and post-therapy were compared. Results: Forty two patients (42/48, 87.50%) showed segmental defects: 'reverse redistribution' on delayed (240 min) 201 Tl images. After medical treatment, 36 cases of the 42 'reverse redistribution' patients had improvement in both clinical symptoms and treadmill exercise test. Post-treatment 201 Tl imaging showed improvement in 45/49 (91.84%) defect segments. Six of the 42 patients had no improvement in clinical symptoms and/or treadmill exercise test. Post-treatment 201 Tl imaging showed no improvement in all the 7 defect segments on the first scan. Conclusion: Dipyridamole stress 201 Tl myocardial SPECT may be valuable in evaluation of impaired coronary microcirculation associated with cardiac syndrome X. (authors)

Relationship between HgbA1c and myocardial blood flow reserve in patients with type 2 diabetes mellitus: noninvasive assessment using real-time myocardial perfusion echocardiography.

Science.gov (United States)

Huang, Runqing; Abdelmoneim, Sahar S; Nhola, Lara F; Mulvagh, Sharon L

2014-01-01

To study the relationship between glycosylated hemoglobin (HgbA1c) and myocardial perfusion in type 2 diabetes mellitus (T2DM) patients, we prospectively enrolled 24 patients with known or suspected coronary artery disease (CAD) who underwent adenosine stress by real-time myocardial perfusion echocardiography (RTMPE). HgbA1c was measured at time of RTMPE. Microbubble velocity (β min(-1)), myocardial blood flow (MBF, mL/min/g), and myocardial blood flow reserve (MBFR) were quantified. Quantitative MCE analysis was feasible in all patients (272/384 segments, 71%). Those with HgbA1c > 7.1% had significantly lower βreserve and MBFR than those with HgbA1c ≤ 7.1% (P relationship was not significant (r = -0.117, P = 0.129). Using a MBFR cutoff value > 2 as normal, HgbA1c > 7.1% significantly increased the risk for abnormal MBFR, (adjusted odds ratio: 1.92, 95% CI: 1.12-3.35, P = 0.02). Optimal glycemic control is associated with preservation of MBFR as determined by RTMPE, in T2DM patients at risk for CAD.

[Stress-ECG is adequate to detect myocardial ischemia: when are additional diagnostic tests needed?].

Science.gov (United States)

Baer, F M

2007-09-01

The stress-ECG is the most often adopted and most cost effective initial diagnostic test for the assessment of myocardial ischemia in patients with suspected coronary artery disease (CAD). Prerequisites for the diagnostic usefullness of stress-ECG are a clearly interpretable ST-segment, ability to reach the predicted work load, an intermediate pretest probability for CAD ranging between 10% and 90% and the absence of any contraindications for dynamic exercise. Because of the limited diagnostic sensitivity of about 70%, and a high percentage of patients, who are unable to exercise, a negative stress ECG can definitely not exclude hemodynamically significant CAD. Therefore, stress imaging techniques like myocardial scintigraphy, stress-echocardiography and stress magnetic resonance imaging play a major role in the stepwise diagnostic work-up of patients with suspected CAD. These stress imaging techniques are basically interchangeable since no method is definitely superior to one of the others. However, each method has its specific pros and cons and inherent contraindications. Therefore the choice of the stress imaging method and the form of stress applied should be based on the individual patients characteristics to gain optimal image quality and diagnostic accuracy. Moreover, the decision for one method should take the local availability and institutional expertise of diagnostic centers into account. Although partly substituted by stress imaging techniques the stress-ECG still remains the workhorse for a stepwise diagnostic work-up of patients with suspected CAD.

Prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia: study by 99mTc-sestamibi radionuclide scintigraphy.

Science.gov (United States)

Ismail, Ahmed M; Rayan, Mona; Adel, Amr; Demerdash, Salah; Atef, Mohamed; Abdallah, Mohamed; Nammas, Wail

2014-02-01

We explored the prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia (CAE), as demonstrated by (99m)Tc-sestamibi scintigraphy. Prospectively, we enrolled 35 patients with angiographically documented CAE and no significant coronary obstruction, who underwent elective coronary angiography. Patients underwent Stress-rest (99m)Tc-sestamibi scintigraphy within 4 days of coronary angiography. They were divided into 2 groups: group I: with normal perfusion scan; and group II: with reversible perfusion defects. The mean age was 49.6 ± 6.9 years; 34 (97.1 %) were males. Seventy-nine (75.2 %) arteries were affected by CAE. Among 79 arteries affected by CAE, affection was diffuse in 37 (46.8 %). Thirteen (37.1 %) patients had normal perfusion scan (group I), whereas 22 (62.9 %) had reversible perfusion defects (group II). Among 22 patients with reversible perfusion defects, 20 (90.9 %) had mild and 2 (9.1 %) had moderate ischemia. Among 49 myocardial segments with reversible perfusion defects, 22 (44.9 %) were basal, 18 (36.7 %) mid-, and 9 (18.4 %) apical segments. Diffuse CAE was significantly more prevalent in group II versus group I, in all 3 major coronary arteries (p < 0.05 for all). In patients with isolated CAE who underwent elective coronary angiography, reversible perfusion defects demonstrated by (99m)Tc-sestamibi scintigraphy were rather prevalent, mostly mild, more likely to affect the basal and mid-segments of the myocardium, and more frequently associated with diffuse ectasia.

One-hour protocol stress myocardial scintigraphy. Prospective study of diagnostic accuracy for the detection of coronary artery stenosis

International Nuclear Information System (INIS)

Matsuda, Junko; Miyamoto, Nobuhide; Onitsuka, Hisamitsu; Ikushima, Ippei; Unoki, Toshihide; Takenaga, Makoto; Koiwaya, Yasushi; Eto, Tanenao

1999-01-01

A one-hour protocol for stress myocardial scintigraphy using technetium-99m-tetrofosmin (Tc-tetrofosmin) was compared with coronary arteriography for the detection of coronary artery stenosis in 90 consecutive patients without prior myocardial infarction, revascularization procedure or vasospastic angina. Tc-tetrofosmin stress myocardial scintigraphy acquired a rest image 20 min after intravenous administration of Tc-tetrofosmin (185 MBq, 1/5 vial) using a three-head gamma camera collecting 20-sec views over 360 deg. The stress test using bicycle ergometer was performed and administration of Tc-tetrofosmin (740 MBq, 4/5 vial) was repeated at the peak stress point. The stress image was acquired 15 min after the second injection with 5-sec views over 360 deg. Coronary arteriography revealed the presence of significant coronary artery stenosis (>75%) in 56 vessels of 45 patients, including 35 patients with single-vessel disease, 5 with two-vessel disease, 2 with three-vessel disease, and 3 with left main trunk disease. The overall sensitivity and specificity for the detection of coronary artery disease by visual analysis were 91.1% and 77.8%, respectively, and by quantitative analyses (using bull's-eye method) were 95.6% and 91.1%, respectively. The individual stenotic vessel sensitivities in the right coronary artery, left anterior descending artery, and left circumflex artery were 84.6%, 90.9%, and 78.6%, respectively. The specificities were 97.3%, 95.9%, and 100.0%, respectively. These results suggest that stress myocardial scintigraphy using the present new protocol is a promising approach for the detection of coronary artery stenosis. (author)

The triterpenoids of Ganoderma tsugae prevent stress-induced myocardial injury in mice.

Science.gov (United States)

Kuok, Qian-Yu; Yeh, Chen-Yu; Su, Bor-Chyuan; Hsu, Pei-Ling; Ni, Hao; Liu, Ming-Yie; Mo, Fan-E

2013-10-01

Ganoderma mushrooms (Lingzhi in Chinese) have well-documented health benefits. Ganoderma tsugae (G. tsugae), one of the ganoderma species, has been commercially cultivated as a dietary supplement. Because G. tsugae has high antioxidant activity and because oxidative stress is often associated with cardiac injury, we hypothesized that G. tsugae protects against cardiac injury by alleviating oxidative stress. We tested the hypothesis using a work-overload-induced myocardial injury model created by challenging mice with isoproterenol (ISO). Remarkably, oral G. tsugae protected the mice from ISO-induced myocardial injury. Moreover, the triterpenoid fraction of G. tsugae, composed of a mixture of nine structurally related ganoderic acids (GAs), provided cardioprotection by inhibiting the ISO-induced expression of Fas/Fas ligand, oxidative stress, and apoptosis. The antioxidant activity of GAs was tested in cultured cardio-myoblast H9c2 cells against the insult of H₂O₂. GAs dissipated the cellular reactive oxygen species imposed by H₂O₂ and prevented cell death. Our findings uncovered the cardioprotective activity of G. tsugae and identified GAs as the bioactive components against cardiac insults. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction.

Science.gov (United States)

Xu, Xiao; Bao, Haikun; Strait, Kelly; Spertus, John A; Lichtman, Judith H; D'Onofrio, Gail; Spatz, Erica; Bucholz, Emily M; Geda, Mary; Lorenze, Nancy P; Bueno, Héctor; Beltrame, John F; Krumholz, Harlan M

2015-02-17

Younger age and female sex are both associated with greater mental stress in the general population, but limited data exist on the status of perceived stress in young and middle-aged patients presenting with acute myocardial infarction. We examined sex difference in stress, contributing factors to this difference, and whether this difference helps explain sex-based disparities in 1-month recovery using data from 3572 patients with acute myocardial infarction (2397 women and 1175 men) 18 to 55 years of age. The average score of the 14-item Perceived Stress Scale at baseline was 23.4 for men and 27.0 for women (Pstress in women was explained largely by sex differences in comorbidities, physical and mental health status, intrafamily conflict, caregiving demands, and financial hardship. After adjustment for demographic and clinical characteristics, women had worse recovery than men at 1 month after acute myocardial infarction, with mean differences in improvement score between women and men ranging from -0.04 for EuroQol utility index to -3.96 for angina-related quality of life (Pstress reduced these sex-based differences in recovery to -0.03 to -3.63, which, however, remained statistically significant (Pstress at baseline was associated with significantly worse recovery in angina-specific and overall quality of life, as well as mental health status. The effect of baseline stress on recovery did not vary between men and women. Among young and middle-aged patients, higher stress at baseline is associated with worse recovery in multiple health outcomes after acute myocardial infarction. Women perceive greater psychological stress than men at baseline, which partially explains women's worse recovery. © 2015 American Heart Association, Inc.

Simultaneous dual-radionuclide myocardial perfusion imaging with a solid-state dedicated cardiac camera

International Nuclear Information System (INIS)

Ben-Haim, Simona; Kacperski, Krzysztof; Hain, Sharon; Van Gramberg, Dean; Hutton, Brian F.; Erlandsson, Kjell; Waddington, Wendy A.; Ell, Peter J.; Sharir, Tali; Roth, Nathaniel; Berman, Daniel S.

2010-01-01

We compared simultaneous dual-radionuclide (DR) stress and rest myocardial perfusion imaging (MPI) with a novel solid-state cardiac camera and a conventional SPECT camera with separate stress and rest acquisitions. Of 27 consecutive patients recruited, 24 (64.5±11.8 years of age, 16 men) were injected with 74 MBq of 201 Tl (rest) and 250 MBq 99m Tc-MIBI (stress). Conventional MPI acquisition times for stress and rest are 21 min and 16 min, respectively. Rest 201 Tl for 6 min and simultaneous DR 15-min list mode gated scans were performed on a D-SPECT cardiac scanner. In 11 patients DR D-SPECT was performed first and in 13 patients conventional stress 99m Tc-MIBI SPECT imaging was performed followed by DR D-SPECT. The DR D-SPECT data were processed using a spill-over and scatter correction method. DR D-SPECT images were compared with rest 201 Tl D-SPECT and with conventional SPECT images by visual analysis employing the 17-segment model and a five-point scale (0 normal, 4 absent) to calculate the summed stress and rest scores. Image quality was assessed on a four-point scale (1 poor, 4 very good) and gut activity was assessed on a four-point scale (0 none, 3 high). Conventional MPI studies were abnormal at stress in 17 patients and at rest in 9 patients. In the 17 abnormal stress studies DR D-SPECT MPI showed 113 abnormal segments and conventional MPI showed 93 abnormal segments. In the nine abnormal rest studies DR D-SPECT showed 45 abnormal segments and conventional MPI showed 48 abnormal segments. The summed stress and rest scores on conventional SPECT and DR D-SPECT were highly correlated (r=0.9790 and 0.9694, respectively). The summed scores of rest 201 Tl D-SPECT and DR-DSPECT were also highly correlated (r=0.9968, p 201 Tl D-SPECT acquisition. (orig.)

Myocardial ischemia in hypertrophic cardiomyopathy

International Nuclear Information System (INIS)

Lima Filho, Moyses de Oliveira; Figueiredo, Geraldo L.; Simoes, Marcus V.; Pyntia, Antonio O.; Marin Neto, Jose Antonio

2000-01-01

Myocardial ischemia in hypertrophic cardiomyopathy is multifactorial and explains the occurrence of angina, in about 50% of patients. The pathophysiology of myocardial ischemia may be explained by the increase of the ventricular mass and relative paucity of the coronary microcirculation; the elevated ventricular filling pressures and myocardial stiffness causing a compression of the coronary microvessels; the impaired coronary vasodilator flow reserve caused by anatomic and functional abnormalities; and the systolic compression of epicardial vessel (myocardial bridges). Myocardial ischemia must be investigated by perfusion scintigraphic methods since its presence influences the prognosis and has relevant clinical implications for management of patients. Patients with hypertrophic cardiomyopathy and documented myocardial ischemia usually need to undergo invasive coronary angiography to exclude the presence of concomitant atherosclerotic coronary disease. (author)

Diallyl trisulfide ameliorates myocardial ischemia-reperfusion injury by reducing oxidative stress and endoplasmic reticulum stress-mediated apoptosis in type 1 diabetic rats: role of SIRT1 activation.

Science.gov (United States)

Yu, Liming; Li, Shu; Tang, Xinlong; Li, Zhi; Zhang, Jian; Xue, Xiaodong; Han, Jinsong; Liu, Yu; Zhang, Yuji; Zhang, Yong; Xu, Yinli; Yang, Yang; Wang, Huishan

2017-07-01

Diallyl trisulfide (DATS) protects against apoptosis during myocardial ischemia-reperfusion (MI/R) injury in diabetic state, although the underlying mechanisms remain poorly defined. Previously, we and others demonstrated that silent information regulator 1 (SIRT1) activation inhibited oxidative stress and endoplasmic reticulum (ER) stress during MI/R injury. We hypothesize that DATS reduces diabetic MI/R injury by activating SIRT1 signaling. Streptozotocin (STZ)-induced type 1 diabetic rats were subjected to MI/R surgery with or without perioperative administration of DATS (40 mg/kg). We found that DATS treatment markedly improved left ventricular systolic pressure and the first derivative of left ventricular pressure, reduced myocardial infarct size as well as serum creatine kinase and lactate dehydrogenase activities. Furthermore, the myocardial apoptosis was also suppressed by DATS as evidenced by reduced apoptotic index and cleaved caspase-3 expression. However, these effects were abolished by EX527 (the inhibitor of SIRT1 signaling, 5 mg/kg). We further found that DATS effectively upregulated SIRT1 expression and its nuclear distribution. Additionally, PERK/eIF2α/ATF4/CHOP-mediated ER stress-induced apoptosis was suppressed by DATS treatment. Moreover, DATS significantly activated Nrf-2/HO-1 antioxidant signaling pathway, thus reducing Nox-2/4 expressions. However, the ameliorative effects of DATS on oxidative stress and ER stress-mediated myocardial apoptosis were inhibited by EX527 administration. Taken together, these data suggest that perioperative DATS treatment effectively ameliorates MI/R injury in type 1 diabetic setting by enhancing cardiac SIRT1 signaling. SIRT1 activation not only upregulated Nrf-2/HO-1-mediated antioxidant signaling pathway but also suppressed PERK/eIF2α/ATF4/CHOP-mediated ER stress level, thus reducing myocardial apoptosis and eventually preserving cardiac function.

Prediction of single versus multivessel disease following myocardial infarction using 201-thallium scintigraphy and electrocardiographic stress testing

International Nuclear Information System (INIS)

Weiss, R.J.; Morise, A.P.; Raabe, D.S. Jr.; Sbarbaro, J.A.

1983-01-01

Fifty patients were evaluated who suffered a single myocardial infarction with graded electrocardiographic stress testing, 201-thallium myocardial perfusion imaging and coronary angiography to assess the role of noninvasive indices as predictors of single versus multivessel coronary artery disease. Multivessel involvement was defined angiographically as the presence of two or more major coronary arteries with at least a 70% intraluminal diameter narrowing. Multivessel disease was defined scintigraphically as the presence of stress and/or redistribution perfusion defects in the distribution of more than one coronary artery. The results of stress electrocardiography were not useful in differentiating patients with single (9/16 positive) versus multivessel (22/34 positive) disease. The degree of exercise-induced ST-segment depression was also not helpful. Stress 201-thallium imaging did offer limited additional information with correct predictions of multivessel disease in 21 of 26 patients. Predictions of single-vessel disease were accurate in 11 of 24 patients. Eleven of these 13 incorrect predictions of single-vessel disease were due to the relative insensitivity of the thallium stress image to perceive defect in the anterior wall when the left anterior descending artery had significant obstruction at catheterization. Further refinements of stress perfusion imaging are needed before this method can be used to reliably separate patients with single and multivessel disease after myocardial infarction

Myocardial imaging with /sup 113m/In- and /sup 99m/Tc-macroaggregated albumin: new procedure for identification of stress-induced regional ischemia

International Nuclear Information System (INIS)

Ritchie, J.L.; Hamilton, G.W.; Gould, K.L.; Allen, D.; Kennedy, J.W.; Hammermeister, K.E.

1975-01-01

Regional coronary blood flow distribution was studied by myocardial imaging after intracoronary injection of technetium-99m- and indium-113m-macroaggregated albumin at rest and during coronary hyperemia induced by intracoronary injection of Hypaque-M, 75 percent. The four- to five-fold increase in coronary flow after injection of radiographic contrast materaial was similar in magnitude to that occurring with maximal exercise stress. Experimentally, resting coronary blood flow and regional distribution of radioactive particles remains normal in spite of coronary stenosis of up to 85 percent. Less severe stenosis causes flow and distribution abnormalities only during periods of increased flow, and the degree of maldistribution is directly related to the physiologic severity of the stenosis. Of 49 patients with suspected coronary artery disease, 10 had no significant lesions by coronary arteriography and all had normal images at rest and during coronary hyperemia. Thirty-seven of 39 patients with significant obstructive coronary artery disease had abnormal images at rest or during contrast agent-induced hyperemia, or both. Patients with significant coronary artery disease without previous infarction usually demonstrated abnormalities in flow distribution only during coronary hyperemia. Patients with previous infarction demonstrated resting perfusion abnormalities that often became more abnormal during hyperemia. This technique provides a new method for assessing the physiologic effects of coronary stenosis in conjunction with coronary arteriography. (U.S.)

Present assessment of myocardial viability by nuclear imaging.

Science.gov (United States)

Saha, G B; MacIntyre, W J; Brunken, R C; Go, R T; Raja, S; Wong, C O; Chen, E Q

1996-10-01

Prospective delineation of viable from nonviable myocardium in patients with coronary artery disease in an important factor in deciding whether a patient should be revascularized or treated medically. Two common techniques--single-photon emission computed tomography (SPECT) and positron-emission computed tomography (PET)--are used in nuclear medicine using various radiopharmaceuticals for the detection of myocardial viability in patients. Thallium-201 (201Tl) and technetium-99m (99mTc)-sestamibi are the common radiopharmaceuticals used in different protocols using SPECT, whereas fluoride-18 (18F)-fluorodeoxyglucose (FDG) and rubidium-82 (82Rb) are most widely used in PET. The SPECT protocols involve stress/redistribution, stress/redistribution/reinjection, and rest/redistribution imaging techniques. Many studies have compared the results of 201Tl and (99mTc)-sestamibi SPECT with those of FDG PET; in some studies, concordant results have been found between delayed thallium and FDG results, indicating that 201Tl, although considered a perfusion agent, shows myocardial viability. Discordant results in a number of studies have been found between sestamibi and FDG, suggesting that the efficacy of sestamibi as a viability marker has yet to be established. Radiolabeled fatty acids such as iodine-123 (123I)-para-iodophenylpentadecanoic acid and carbon-11 (11C)-palmitic acid have been used for the assessment of myocardial viability with limited success. 11C-labeled acetate is a good marker of oxidative metabolism in the heart and has been used to predict the reversibility of wall motion abnormalities. (18F)-FDG is considered the marker of choice for myocardial viability, although variable results are obtained under different physiological conditions. Detection of myocardial viability can be greatly improved by developing new equipment and radiopharmaceuticals of better quality.

Diagnostic accuracy of an artificial neural network compared with statistical quantitation of myocardial perfusion images. A Japanese multicenter study

Energy Technology Data Exchange (ETDEWEB)

Nakajima, Kenichi; Matsuo, Shinro [Kanazawa University Hospital, Kanazawa (Japan); Kudo, Takashi [Nagasaki University Hospital, Nagasaki (Japan); Nakata, Tomoaki [Hakodate Goryoukaku Hospital, Hakodate (Japan); Kiso, Keisuke [National Cerebral and Cardiovascular Center, Suita (Japan); Kasai, Tokuo [Tokyo Medical University Hachioji Medical Center, Hachioji (Japan); Taniguchi, Yasuyo [Hyogo Brain and Heart Center, Himeji (Japan); Momose, Mitsuru [Tokyo Women' s Medical University, Tokyo (Japan); Nakagawa, Masayasu [Akita City Hospital, Akita (Japan); Sarai, Masayoshi [Fujita Health University Hospital, Toyoake (Japan); Hida, Satoshi [Tokyo Medical University Hospital, Tokyo (Japan); Tanaka, Hirokazu [Tokyo Medical University Ibaraki Medical Center, Ibaraki (Japan); Yokoyama, Kunihiko [Public Central Hospital of Matto Ishikawa, Hakusan (Japan); Okuda, Koichi [Kanazawa Medical University, Kahoku (Japan); Edenbrandt, Lars [University of Gothenburg, Gothenburg (Sweden)

2017-12-15

Artificial neural networks (ANN) might help to diagnose coronary artery disease. This study aimed to determine whether the diagnostic accuracy of an ANN-based diagnostic system and conventional quantitation are comparable. The ANN was trained to classify potentially abnormal areas as true or false based on the nuclear cardiology expert interpretation of 1001 gated stress/rest {sup 99m}Tc-MIBI images at 12 hospitals. The diagnostic accuracy of the ANN was compared with 364 expert interpretations that served as the gold standard of abnormality for the validation study. Conventional summed stress/rest/difference scores (SSS/SRS/SDS) were calculated and compared with receiver operating characteristics (ROC) analysis. The ANN generated a better area under the ROC curves (AUC) than SSS (0.92 vs. 0.82, p < 0.0001), indicating better identification of stress defects. The ANN also generated a better AUC than SDS (0.90 vs. 0.75, p < 0.0001) for stress-induced ischemia. The AUC for patients with old myocardial infarction based on rest defects was 0.97 (0.91 for SRS, p = 0.0061), and that for patients with and without a history of revascularization based on stress defects was 0.94 and 0.90 (p = 0.0055 and p < 0.0001 vs. SSS, respectively). The SSS/SRS/SDS steeply increased when ANN values (probability of abnormality) were >0.80. The ANN was diagnostically accurate in various clinical settings, including that of patients with previous myocardial infarction and coronary revascularization. The ANN could help to diagnose coronary artery disease. (orig.)

Diagnostic accuracy of an artificial neural network compared with statistical quantitation of myocardial perfusion images. A Japanese multicenter study

International Nuclear Information System (INIS)

Nakajima, Kenichi; Matsuo, Shinro; Kudo, Takashi; Nakata, Tomoaki; Kiso, Keisuke; Kasai, Tokuo; Taniguchi, Yasuyo; Momose, Mitsuru; Nakagawa, Masayasu; Sarai, Masayoshi; Hida, Satoshi; Tanaka, Hirokazu; Yokoyama, Kunihiko; Okuda, Koichi; Edenbrandt, Lars

2017-01-01

Artificial neural networks (ANN) might help to diagnose coronary artery disease. This study aimed to determine whether the diagnostic accuracy of an ANN-based diagnostic system and conventional quantitation are comparable. The ANN was trained to classify potentially abnormal areas as true or false based on the nuclear cardiology expert interpretation of 1001 gated stress/rest 99m Tc-MIBI images at 12 hospitals. The diagnostic accuracy of the ANN was compared with 364 expert interpretations that served as the gold standard of abnormality for the validation study. Conventional summed stress/rest/difference scores (SSS/SRS/SDS) were calculated and compared with receiver operating characteristics (ROC) analysis. The ANN generated a better area under the ROC curves (AUC) than SSS (0.92 vs. 0.82, p < 0.0001), indicating better identification of stress defects. The ANN also generated a better AUC than SDS (0.90 vs. 0.75, p < 0.0001) for stress-induced ischemia. The AUC for patients with old myocardial infarction based on rest defects was 0.97 (0.91 for SRS, p = 0.0061), and that for patients with and without a history of revascularization based on stress defects was 0.94 and 0.90 (p = 0.0055 and p < 0.0001 vs. SSS, respectively). The SSS/SRS/SDS steeply increased when ANN values (probability of abnormality) were >0.80. The ANN was diagnostically accurate in various clinical settings, including that of patients with previous myocardial infarction and coronary revascularization. The ANN could help to diagnose coronary artery disease. (orig.)

Sex-dependent effects of chronic psychosocial stress on myocardial sensitivity to ischemic injury.

Science.gov (United States)

Rorabaugh, Boyd R; Krivenko, Anna; Eisenmann, Eric D; Bui, Albert D; Seeley, Sarah; Fry, Megan E; Lawson, Joseph D; Stoner, Lauren E; Johnson, Brandon L; Zoladz, Phillip R

2015-01-01

Individuals with post-traumatic stress disorder (PTSD) experience many debilitating symptoms, including intrusive memories, persistent anxiety and avoidance of trauma-related cues. PTSD also results in numerous physiological complications, including increased risk for cardiovascular disease (CVD). However, characterization of PTSD-induced cardiovascular alterations is lacking, especially in preclinical models of the disorder. Thus, we examined the impact of a psychosocial predator-based animal model of PTSD on myocardial sensitivity to ischemic injury. Male and female Sprague-Dawley rats were exposed to psychosocial stress or control conditions for 31 days. Stressed rats were given two cat exposures, separated by a period of 10 days, and were subjected to daily social instability throughout the paradigm. Control rats were handled daily for the duration of the experiment. Rats were tested on the elevated plus maze (EPM) on day 32, and hearts were isolated on day 33 and subjected to 20 min ischemia and 2 h reperfusion on a Langendorff isolated heart system. Stressed male and female rats gained less body weight relative to controls, but only stressed males exhibited increased anxiety on the EPM. Male, but not female, rats exposed to psychosocial stress exhibited significantly larger infarcts and attenuated post-ischemic recovery of contractile function compared to controls. Our data demonstrate that predator stress combined with daily social instability sex-dependently increases myocardial sensitivity to ischemic injury. Thus, this manipulation may be useful for studying potential mechanisms underlying cardiovascular alterations in PTSD, as well as sex differences in the cardiovascular stress response.

Relevance of tissue Doppler in the quantification of stress echocardiography for the detection of myocardial ischemia in clinical practice

Directory of Open Access Journals (Sweden)

Sicari Rosa

2005-01-01

Full Text Available Abstract In the present article we review the main published data on the application of Tissue Doppler Imaging (TDI to stress echocardiography for the detection of myocardial ischemia. TDI has been applied to stress echocardiography in order to overcome the limitations of visual analysis for myocardial ischemia. The introduction of a new technology for clinical routine use should pass through the different phases of scientific assessment from feasibility studies to large multicenter studies, from efficacy to effectiveness studies. Nonetheless the pro-technology bias plays a major role in medicine and expensive and sophisticated techniques are accepted before their real usefulness and incremental value to the available ones is assessed. Apparently, TDI is not exempted by this approach : its applications are not substantiated by strong and sound results. Nonetheless, conventional stress echocardiography for myocardial ischemia detection is heavily criticized on the basis of its subjectivity. Stress echocardiography has a long lasting history and the evidence collected over 20 years positioned it as an established tool for the detection and prognostication of coronary artery disease. The quantitative assessment of myocardial ischemia remains a scientific challenge and a clinical goal but time has not come for these newer ultrasonographic techniques which should be restricted to research laboratories.

Impaired transcriptional activity of Nrf2 in age-related myocardial oxidative stress is reversible by moderate exercise training.

Directory of Open Access Journals (Sweden)

Sellamuthu S Gounder

Full Text Available Aging promotes accumulation of reactive oxygen/nitrogen species (ROS/RNS in cardiomyocytes, which leads to contractile dysfunction and cardiac abnormalities. These changes may contribute to increased cardiovascular disease in the elderly. Inducible antioxidant pathways are regulated by nuclear erythroid 2 p45-related factor 2 (Nrf2 through antioxidant response cis-elements (AREs and are impaired in the aging heart. Whereas acute exercise stress (AES activates Nrf2 signaling and promotes myocardial antioxidant function in young mice (~2 months, aging mouse (>23 months hearts exhibit significant oxidative stress as compared to those of the young. The purpose of this study was to investigate age-dependent regulation of Nrf2-antioxidant mechanisms and redox homeostasis in mouse hearts and the impact of exercise. Old mice were highly susceptible to oxidative stress following high endurance exercise stress (EES, but demonstrated increased adaptive redox homeostasis after moderate exercise training (MET; 10m/min, for 45 min/day for ~6 weeks. Following EES, transcription and protein levels for most of the ARE-antioxidants were increased in young mice but their induction was blunted in aging mice. In contrast, 6-weeks of chronic MET promoted nuclear levels of Nrf2 along with its target antioxidants in the aging heart to near normal levels as seen in young mice. These observations suggest that enhancing Nrf2 function and endogenous cytoprotective mechanisms by MET, may combat age-induced ROS/RNS and protect the myocardium from oxidative stress diseases.

Prognostic value of technetium-99m-labeled single-photon emission computerized tomography in the follow-up of patients after their first myocardial revascularization surgery

Directory of Open Access Journals (Sweden)

Márcia Maria Sales dos Santos

2003-01-01

Full Text Available OBJECTIVE: To assess the prognostic value of Technetium-99m-labeled single-photon emission computerized tomography (SPECT in the follow-up of patients who had undergone their first myocardial revascularization. METHODS: We carried out a retrospective study of 280 revascularized patients undergoing myocardial scintigraphy under stress (exercise or pharmacological stress with dipyridamole and at rest according to a 2-day protocol. A set of clinical, stress electrocardiographic and scintigraphic variables was assessed. Cardiac events were classified as "major" (death, infarction, unstable angina and "any" (major event or coronary angioplasty or new myocardial revascularization surgery. RESULTS: Thirty-six major events occurred as follows: 3 deaths, 11 infarctions, and 22 unstable anginas. In regard to any event, 22 angioplasties and 7 new surgeries occurred in addition to major events, resulting a total of 65 events. The sensitivity of scintigraphy in prognosticating a major event or any event was, respectively, 55% and 58%, showing a negative predictive value of 90% and 83%, respectively. Diabetes mellitus, inconclusive stress electrocardiography, and a scintigraphic visualization of left ventricular enlargement were significant variables for the occurrence of a major event. On multivariate analysis, abnormal myocardial scintigraphy was a predictor of any event. CONCLUSION: Myocardial perfusion tomography with Technetium-99m may be used to identify high-risk patients after their first myocardial revascularization surgery.

Safety of adenosine stress myocardial perfusion imaging by a one-route infusion protocol

International Nuclear Information System (INIS)

Kawai, Yuko; Kishino, Koh

2006-01-01

When adenosine stress testing is performed, a vein is generally accessed in each arm. To determine whether the one-route infusion protocol, that is, infusion via one upper arm vein, is safe, myocardial perfusion imaging was performed during adenosine stress testing in patients with angina pectoris. Sixty-six consecutive patients (43 men, 68±11 years of age) with suspected coronary artery disease were enrolled in this study. For the stress test, adenosine was injected at 120 μg/kg/min for 6 minutes. Systolic blood pressure, diastolic blood pressure, and heart rate did not show any significant changes after injection of the adenosine and radioisotope (RI) tracer. Adverse events during infusion of the adenosine were seen in 42 (64%) patients and included chest discomfort/oppression in 17 (26%) and dyspnea/throat discomfort in 15 (23%). On the other hand, adverse events just after infusion of the RI tracer occurred in 5 (8%) patients and included chest oppression in 2 (3%) and dyspnea in 1 (2%). Almost all adverse events disappeared quickly without treatment. Therefore, we concluded that adenosine stress myocardial perfusion imaging using a one-route infusion protocol is safe and useful to do for patients unable to secure veins in both arms. (author)

52 Genetic Loci Influencing Myocardial Mass

DEFF Research Database (Denmark)

van der Harst, Pim; van Setten, Jessica; Verweij, Niek

2016-01-01

BACKGROUND: Myocardial mass is a key determinant of cardiac muscle function and hypertrophy. Myocardial depolarization leading to cardiac muscle contraction is reflected by the amplitude and duration of the QRS complex on the electrocardiogram (ECG). Abnormal QRS amplitude or duration reflect cha...

Hypertension impairs myocardial blood perfusion reserve in subjects without regional myocardial ischemia

International Nuclear Information System (INIS)

Nakajima, Hiroshi; Onishi, Katsuya; Kurita, Tairo

2010-01-01

Quantitative analysis of myocardial perfusion MRI can provide noninvasive assessments of myocardial perfusion reserve (MPR), which is associated with endothelial function. Endothelial function is influenced by various factors, including hypertension, diabetes, dyslipidemia, renal dysfunction and anemia. The purpose of this study was to evaluate which risk factor is the strongest effector of MPR in subjects without regional myocardial ischemia. We studied 110 patients (66 years ±10, male 68%, hypertension 76%, diabetes mellitus (DM) 40% and dyslipidemia 65%) without regional myocardial ischemia. Adenosine triphosphate (ATP) stress and rest first-pass perfusion magnetic resonance (MR) images were acquired with a 1.5-T MR system, and MPR was calculated as the ratio of stress to rest myocardial blood flow (MBF). Average rest MBF in 110 patients was 1.07±0.62 ml min -1 g -1 , whereas stress MBF was 3.15±1.93 ml min -1 g -1 and the MPR was 3.33±1.82. Rest MBF correlated significantly with hematocrit, whereas stress MBF showed a strong correlation with estimated glomerular filtration rate (e-GFR). MPR was associated with hypertension, age, e-GFR, hematocrit and left ventricular mass index (LVMI). In multiple regression analysis, hypertension (P=0.003, β=-0.274) showed the strongest correlation with MPR among other risk factors, such as diabetes (P=ns), dyslipidemia (P=ns), e-GFR (P=ns), LVMI (P=0.007, β=-0.248) and hematocrit (P=ns) after adjusting age and gender. Hypertension is the most important effector of MPR in subjects without myocardial ischemia. (author)

Hypertension impairs myocardial blood perfusion reserve in subjects without regional myocardial ischemia

Energy Technology Data Exchange (ETDEWEB)

Nakajima, Hiroshi; Onishi, Katsuya; Kurita, Tairo [Mie Univ., Graduate School of Medicine, Tsu, Mie (Japan)

2010-11-15

Quantitative analysis of myocardial perfusion MRI can provide noninvasive assessments of myocardial perfusion reserve (MPR), which is associated with endothelial function. Endothelial function is influenced by various factors, including hypertension, diabetes, dyslipidemia, renal dysfunction and anemia. The purpose of this study was to evaluate which risk factor is the strongest effector of MPR in subjects without regional myocardial ischemia. We studied 110 patients (66 years {+-}10, male 68%, hypertension 76%, diabetes mellitus (DM) 40% and dyslipidemia 65%) without regional myocardial ischemia. Adenosine triphosphate (ATP) stress and rest first-pass perfusion magnetic resonance (MR) images were acquired with a 1.5-T MR system, and MPR was calculated as the ratio of stress to rest myocardial blood flow (MBF). Average rest MBF in 110 patients was 1.07{+-}0.62 ml min{sup -1} g{sup -1}, whereas stress MBF was 3.15{+-}1.93 ml min{sup -1} g{sup -1} and the MPR was 3.33{+-}1.82. Rest MBF correlated significantly with hematocrit, whereas stress MBF showed a strong correlation with estimated glomerular filtration rate (e-GFR). MPR was associated with hypertension, age, e-GFR, hematocrit and left ventricular mass index (LVMI). In multiple regression analysis, hypertension (P=0.003, {beta}=-0.274) showed the strongest correlation with MPR among other risk factors, such as diabetes (P=ns), dyslipidemia (P=ns), e-GFR (P=ns), LVMI (P=0.007, {beta}=-0.248) and hematocrit (P=ns) after adjusting age and gender. Hypertension is the most important effector of MPR in subjects without myocardial ischemia. (author)

[Follow-up of patients with good exercise capacity in stress test with myocardial single-photon emission computed tomography (SPECT)].

Science.gov (United States)

González, Javiera; Prat, Hernán; Swett, Eduardo; Berrocal, Isabel; Fernández, René; Zhindon, Juan Pablo; Castro, Ariel; Massardo, Teresa

2015-11-01

The evaluation of coronary artery disease (CAD) can be performed with stress test and myocardial SPECT tomography. To assess the predictive value of myocardial SPECT using stress test for cardiovascular events in patients with good exercise capacity. We included 102 males aged 56 ± 10 years and 19 females aged 52 ± 10 years, all able to achieve 10 METs and ≥ 85% of the theoretical maximum heart rate and at least 8 min in their stress test with gated 99mTc-sestamibi SPECT. Eighty two percent of patients were followed clinically for 33 ± 17 months. Sixty seven percent of patients were studied for CAD screening and the rest for known disease assessment. Treadmill stress test was negative in 75.4%; 37% of patients with moderate to severe Duke Score presented ischemia. Normal myocardial perfusion SPECT was observed in 70.2%. Reversible defects appeared in 24.8% of cases, which were of moderate or severe degree (> 10% left ventricular extension) in 56.6%. Only seven cases had coronary events after the SPECT. Two major (myocardial infarction and emergency coronary revascularization) and 5 minor events (elective revascularization) ere observed in the follow-up. In a multivariate analysis, SPECT ischemia was the only statistically significant parameter that increased the probability of having a major or minor event. Nearly a quarter of our patients with good exercise capacity demonstrated reversible defects in their myocardial perfusion SPECT. In the intermediate-term follow-up, a low rate of cardiac events was observed, being the isotopic ischemia the only significant predictive parameter.

Usefulness of {sup 201}Tl myocardial perfusion SPECT in prediction of left ventricular remodeling following an acute myocardial infarction

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Yoon, Seok Nam; Park, C. H.; Hwang, Kyung Hoon [Ajou Univ. College of Medicine, Suwon (Korea, Republic of)

2000-02-01

We investigated the role of myocardial perfusion SPECT in prediction of ventricular dilatation and the role of revascularization including thrombolytic therapy and PTCA in prevention of ventricular dilatation after an acute myocardial linfarction (AMI). We performed dipyridamole stress, 4 hour redistribution, and 24 hour reinjection Tl-201 SPECT in 6 patients with AMI two to nine days after attack. Perfusion and wall motion abnormalities were quantified by perfusion index(PI) and wall motion index (WMI). Left ventricular ejection fraction (LVEF), WMI and ventricular volume were measured within 1 week of AMI and after average of 6 months. According to serial changes of left ventricular end-diastolic volume (LVEDV), patients were divided into two groups. We compared WMI, PI and LVEF between the two groups. Relationships among degree of volume, stress-rest PI, WMI, CKMB,Q wave, LVEF and revascularization were analysed using multivariate analysis. Only initial rest perfusion index was significantly different between the two groups (p<0.05). While initial LVEF, stress PI, CKMB, trial of revascularization procedure, presence of Q wave and WMI were not significantly different between the two groups. Eight of 16 patients (50%) showed LV dilatation on follow-up echocardiography. Three of 3 patients (100%) who did not undergo revascualrization procedure documented LV dilatation. And only 5 (38%) of the remaining 13 patients who underwent revascularization revealed LV dilatation. There was no difference in infarct location between the two groups. By multivariate linear regression analysis in patients only undergoing revascularization, rest perfusion index was the only significant factor. Myocardial perfusion SPECT performed prior to revascularization was useful in prediction of LV dilatation after an AMI. Rest perfusion index on myocardial perfusion plays as a significant predictor of left ventricular dilatation after AMI. And revascularization appears to be a valuable

Myocardial perfusion SPECT in diabetic patients for detection of coronary artery disease

International Nuclear Information System (INIS)

Saeed, M.A.; Fatima, S.; Fatmi, S.; Kureshi, S.

2003-01-01

The aim of this study was to evaluate the efficacy of myocardial SPECT perfusion scan in the diagnosis of coronary artery disease in diabetic patients. A total number of thirty diabetic patients (21 males, 9 females) were included in the study. All the patients had strong risk-factors for coronary artery disease (strong family history, chronic smokers, hyperlipidemia, history of chest pain). All patients underwent coronary angiography and stress/rest myocardial perfusion SPECT scans with Tc-99m MIBI (two days protocol). Twenty two patients had significant coronary artery stenosis and 8 had normal coronary arteries. Myocardial perfusion scintigraphy (MPS) was positive in 19 subjects out of the 22 patients with significant stenosis (Sensitivity 86.4%) and negative (false negative) in only three. Out of 8 patients with normal angiography 7 had normal MPS (Specificity 87.5%) whereas only one patient revealed abnormality in the myocardial perfusion study. When compared with coronary angiography the positive predictive value and negative predictive value for Tc-99m MIBI myocardial perfusion scan was 86.4% and 87.5% respectively. In conclusion, Tc-99m MIBI myocardial perfusion scintigraphy is a useful screening modality for the detection of coronary artery disease in diabetic patients. (author)

Mechanism underlying the absence of ischemic changes on the exercise electrocardiogram in patients with abnormal exercise thallium-201 imaging and coronary artery disease

International Nuclear Information System (INIS)

Coplan, N.L.; Horowitz, S.F.; Hoffman, D.P.; Goldman, M.E.; Machac, J.

1985-01-01

Patients with coronary artery disease may have reversible abnormalities on a thallium myocardial perfusion study without simultaneous ischemic changes on the exercise electrocardiogram, but the mechanisms responsible for this disparity have not been fully elucidated. A group of 37 patients with angiographically demonstrated coronary artery disease and abnormal thallium perfusion imaging were divided into two groups on the basis of their exercise electrocardiographic ST segment response. Thirteen patients (Group A) had no significant electrocardiographic changes with exercise, while 24 patients (Group B) had ST changes consistent with ischemia during the test. There were no significant differences in clinical or angiographic characteristics between the two groups. Stress test results showed a similar mean duration of exercise in the two groups, but the patients in Group A achieved a significantly lower mean maximal heart rate and mean maximal double product. These results suggest that exercise thallium-electrocardiogram discordance is mediated by the level of myocardial workload achieved. An abnormal perfusion scan accompanying an exercise electrocardiogram which does not demonstrate any ischemic ST change may occur when there is sufficient increase in myocardial oxygen demand to result in differential augmentation of myocardial blood flow, but insufficient imbalance of supply and demand to result in signs of ischemia on the surface electrocardiogram

Myocardial kinetics of thallium-201 after stress in normal and perfusion-reduced canine myocardium

International Nuclear Information System (INIS)

Okada, R.D.

1985-01-01

Despite the emerging use of quantitative computer programs for assessing myocardial thallium uptake and clearance after exercise, little is known about the kinetics of thallium after exercise stress. Accordingly, 11 mongrel dogs with experimental left anterior descending coronary stenoses were given thallium during norepinephrine infusion to simulate exercise. The infusion was discontinued and thallium activity was monitored regionally using miniature radiation detectors for 3 hours. Heart rate, arterial pressure and double product all increased significantly during norepinephrine infusion. The mean fractional myocardial thallium clearance was lower (0.47 +/- 0.03 [+/- standard error of the mean]) for the stenosis zone than for the no-stenosis zone (0.57 +/- 0.03) (p less than 0.0001). The stress blood flow ratio (stenosis/no-stenosis zone = 0.27 +/- 0.06) was significantly lower than the final thallium activity ratio (0.68 +/- 0.07) (p less than 0.001), consistent with thallium redistribution occurring over the 3-hour period. Myocardial thallium activity in the stenosis zone peaked in a mean of 2.2 minutes, then washed out biexponentially with a final decay constant of 0.0035 +/- 0.0005 min-1. Myocardial thallium activity in the no-stenosis zone peaked within 1 minute in all dogs, then washed out biexponentially, with a final decay constant of 0.0043 +/- 0.0003 (p less than 0.001 compared with stenosis zone). In conclusion, fractional clearance of thallium can differentiate myocardium distal to a coronary artery stenosis from that supplied by a normal coronary vessel

Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease

International Nuclear Information System (INIS)

Ozaki, Nobuchika; Sugimoto, Takaki; Okada, Masayoshi

1999-01-01

To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n=21): %FS has improved late after operation; Group B (n=16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84±54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS (Δ%FS) was used for assessment. Seven patients in Group A had showed Δ%FS of more than 9%, while all patients in Group B had showed Δ%FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. (author)

Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease

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Ozaki, Nobuchika; Sugimoto, Takaki; Okada, Masayoshi [Kobe Univ. (Japan). School of Medicine

1999-02-01

To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n=21): %FS has improved late after operation; Group B (n=16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84{+-}54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS ({delta}%FS) was used for assessment. Seven patients in Group A had showed {delta}%FS of more than 9%, while all patients in Group B had showed {delta}%FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. (author)

Myocardial contusion following nonfatal blunt chest trauma

International Nuclear Information System (INIS)

Kumar, S.A.; Puri, V.K.; Mittal, V.K.; Cortez, J.

1983-01-01

Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma

Myocardial ischemia and angina pectoris. The clinical problem in patients

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Selwyn, A.P.; Fox, K.M.; Jonathan, A.; Lavender, P.; Watson, I.

1981-02-01

Ambulatory monitoring of ST segment changes was performed in 60 patients presenting with angina, positive ECG stress tests and coronary artery disease, 85% of ischemic ECG events were asymptomatic, 37% occurred with no increase in heart rate and 15% of episodes either lasted 20 minutes or more or fluctuated in severity. A controlled pilot study in ten patients showed depression. Radionuclide studies in 50 patients with angina and coronary artery disease have shown that stress (i.e., atrial pacing) produced different patterns of disturbed regional myocardial perfusion related to the patient's exercise capacity and eventually leading to a decrease in regional myocardial perfusion during the ischemic episode. ST segment depression appeared only after the decrease in regional myocardial perfusion. These findings combined with past research suggest that patients with angina and coronary artery disease can suffer frequent asymptomatic disturbances of the regional myocardial perfusion. The frequency of these episodes and the time course for the recovery of the metabolic consequences mean that segments of ventricular myocardium may be constantly abnormal. The relative importance of changes in coronary tone and malfunction of platelets in the diseased coronary tree needs to be examined in clinical research. Pilot studies of antiplatelet agents have shown a significant beneficial effect on episodes of ischemia occurring at night and those occurring without any increase in heart rate. The techniques and observations in these patients with coronary artery disease all suggest that acute transient regional myocardial ischemia is caused by a variety of mechanisms. Further research using objective methods is required to discover the causes of ischemia and to rationalize treatment.

Myocardial ischemia detection by artificial intelligence interpretation of Tl-201 tomograms

International Nuclear Information System (INIS)

Herbst, M.D.; Garcia, E.V.; Cooke, C.D.; Folks, R.D.; Ezquerra, N.F.

1989-01-01

This paper reports on an expert system environment which automatically assigned certainty factors to abnormal regions in stress and delayed myocardial thallium-201 polar bulls-eye plots. MYCIN-type algorithms propagated certainty factors for the presence, location, and character of each coronary lesion. Ninety-four previously validated rules that considered only stress perfusion defects spawned 91 new rules considering tracer redistribution. Fifteen new rules assessed vascular territories for the presence and location of fixed or reversible defects. This artificial intelligence tool can provide novice readers of cardiac T1-201 studies automatic, consistent, objective, and justified interpretations that consider artifacts, coronary territory overlap, and multiple defects

Thallium-201 myocardial imaging in acute-myocardial infarction

International Nuclear Information System (INIS)

Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Wellens, H.J.J.; Samson, G.; Schoot, J.B. van der

1980-01-01

Thallium-201 scintigraphy has proven to be an early and highly sensitive technique to detect myocardial perfusion abnormalities in patients with acute myocardial infarction. During the early phase of acute myocardial infarction, patients may be hemodynamically and electrically unstable. Therefore, scintigraphy is performed preferably at the bed side in the Coronary Care Unit using a mobile gamma camera. Additionally, in order to shorten imaging time in these often critically ill patients, the authors recommend injecting no less than 2 mCi of 201 Tl. Using this dosage, the imaging time per view will be approximately five minutes. Routinely, three views are taken: the first view is a supine 45 0 left-anterior-oblique view, followed by a supine anterior view and finally a left-lateral view, the latter with the patient turned on the right side. (Auth.)

Diagnosis of coronary artery disease using myocardial perfusion SPECT in patients with diabetes mellitus: analysis of risk factors

International Nuclear Information System (INIS)

Seo, Ji Hyoung; Kang, Seong Min; Bae, Jin Ho; Jeong, Shin Young; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae

2006-01-01

Diabetes mellitus is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. 203 diabetic patients (64 male, mean age 64.1 ± 9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36 ± 18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the occurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events

Diagnosis of coronary artery disease using myocardial perfusion SPECT in patients with diabetes mellitus: analysis of risk factors

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Seo, Ji Hyoung; Kang, Seong Min; Bae, Jin Ho; Jeong, Shin Young; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae [Kyungpook National University, Daegu, (Korea, Republic of)

2006-06-15

Diabetes mellitus is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. 203 diabetic patients (64 male, mean age 64.1 {+-} 9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36 {+-} 18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the occurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events.

Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

International Nuclear Information System (INIS)

Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

1988-01-01

The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina

Comparative study of body surface isopotential map, left ventriculogram and thallium-201 myocardial scintigram in patients with old lateral myocardial infarction

International Nuclear Information System (INIS)

Matsumoto, Naoyuki

1988-01-01

In 16 patients with old lateral myocardial infarction, body surface isopotential maps and 12 lead electrocardiograms were compared with left ventriculographic findings. In addition 8 of these subjects were performed thallium-201 myocardial scintigraphy in order to determine the location and extent of myocardial necrosis. Common 12 lead electrocardiographic findings of the subjects were initial Q waves more than 30 msec and inverted T waves in only aVL lead. The patients were classified into 4 groups according to the location and extent of ventricular wall motion abnormalities group I (6 cases) showed hypokinesis in the anterior segment, group II (5 cases): akinesis in the anterior segment and hypokinesis in the seg. 6, group III (4 cases): hypokinesis in the anterior segment and seg. 7, group IV (1 case): hypokinesis in the anterior segment and seg. 4, 7. And each of the 4 groups demonstrated characteristic findings of surface isopotential maps. Group II with coexisting hypokinesis in the seg. 6 showed surface isopotential maps additional pattern of anterior myocardial infarction, and group III with coexisting hypokinesis in the seg. 7 showed additional patterns of posterior myocardial infarction. The classification according to the abnormality of ventricular wall motion was also conformed with the thallium-201 myocardial scintigraphic findings except one case. These results suggest that body surface isopotential map is more useful than the 12 lead electrocardiogram in detecting the location and extent of left ventricular wall motion abnormality in patients with old lateral myocardial infarction. (author) 53 refs

Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia

International Nuclear Information System (INIS)

Schuler, G.; Schlierf, G.; Wirth, A.

1988-01-01

The effects of physical exercise and normalization of serum lipoproteins on stress-induced myocardial ischemia were studied in 18 patients with coronary artery disease, stable angina pectoris, and mild hypercholesterolemia (total serum cholesterol 242 +/- 32 mg/dl). These patients underwent a combined regimen of low-fat/low-cholesterol diet and regular, supervised physical exercise at high intensity for 12 months. At 1 year serum lipoproteins has been lowered to ideal levels (serum cholesterol 202 +/- 31 mg/dl, low-density lipoproteins 130 +/- 30 mg/dl, very low-density lipoproteins 22 +/- 15 mg/dl, serum triglycerides 105 [69 to 304] mg/dl) and physical work capacity was improved by 21% (p less than .01). No significant effect was noted on high-density lipoproteins, probably as a result of the low-fat/high-carbohydrate diet. Stress-induced myocardial ischemia, as assessed by thallium-201 scintigraphy, was decreased by 54% (p less than .05) despite higher myocardial oxygen consumption. Eighteen patients matched for age and severity of coronary artery disease served as a control group and ''usual medical care'' was rendered by their private physicians. No significant changes with respect to serum lipoproteins, physical work capacity, maximal rate-pressure product, or stress-induced myocardial ischemia were observed in this group. These data indicate that regular physical exercise at high intensity, lowered body weight, and normalization of serum lipoproteins may alleviate compromised myocardial perfusion during stress

Improved noninvasive assessment of coronary artery disease by quantitative analysis of regional stress myocardial distribution and washout of thallium-201

International Nuclear Information System (INIS)

Maddahi, J.; Garcia, E.V.; Berman, D.S.; Waxman, A.; Swan, H.J.C.; Forrester, J.

1981-01-01

Visual interpretation of stress-redistribution thallium-201 ( 201 Tl) scintigrams is subject to observer variability and is suboptimal for evaluation of extent of coronary artery disease (CAD). An objective, computerized technique has been developed that quantitatively expresses the relative space-time myocardial distribution of 201 Tl. Multiple-view, maximum-count circumferential profiles for stress myocardial distribution of 201 Tl and segmental percent washout were analyzed in a pilot group of 31 normal subjects and 20 patients with CAD to develop quantitative criteria for abnormality. Subsequently, quantitative analysis was applied prospectively to a group of 22 normal subjects and 45 CAD patients and compared with visual interpretation of scintigrams for detection and evaluation of CAD. The sensitivity and specificity of the quantitative technique (93% and 91%, respectively) were not significantly different from those of the visual method (91% and 86%). The quantitative analysis significantly (p 201 Tl imaging over the visual method in the left anterior descending artery (from 56% to 80%), left circumflex artery (from 34% to 63%) and right coronary artery (from 65% to 94%) without significant loss of specificity. Using quantitative analysis, sensitivity for detection of deseased vessels did not diminish as the number of vessels involved increased, as it did with visual interpretations. In patients with one-vessel disease, 86% of the lesions were detected by both techniques; however, in patients with three-vessel disease, quantitative analysis detected 83% of the lesions, while the sensitivity was only 53% for the visual method. Seventy percent of the coronary arteries with moderate

The clinical usefulness of myocardial thallium-201 washout rate after exercise stress

International Nuclear Information System (INIS)

Iwasaki, Tsutomu; Takino, Yutaka; Sakurai, Fumio

1989-01-01

Myocardial Tl-201 Washout rates (WORs) after exercise stress were measured in 15 normal subjects and 67 patients with coronary artery disease (CAD) or chest pain syndrome and the usefulness of WOR for the detection of CAD was studied. Myocardial tomograms were obtained both immediately after exercise and 3 hours later using a rotating gamma camera in 15 normal subjects and 67 patients. After low-pass filtering, images were reconstructed into short-axis, horizontal long-axis and vertical long-axis tomograms and visually interpreted. By using short-axis tomograms, left ventricle WORs were expressed as circumferential profile curves at the apex, center and base of the ventricle. Lower normal limits of the WOR were set at 2 SDs from the mean of the normal subjects. The combination of visual interpretation of SPECT with WOR increased the sensitivity of detection of CAD from 8.3% to 66.7% in patients with three-vessel CAD without losing specificity. WOR after exercise stress is believed to be a useful method of detecting multivessel CAD. (author)

Illness perceptions of fatigue and the association with sense of coherence and stress in patients one year after myocardial infarction.

Science.gov (United States)

Alsén, Pia; Eriksson, Monica

2016-02-01

To explore the associations between illness perceptions of fatigue, sense of coherence and stress in patients one year after myocardial infarction. Post-myocardial infarction fatigue is a stressful symptom that is difficult to cope with. Patients' illness perceptions of fatigue guide professionals in predicting how individuals will respond emotionally and cognitively to symptoms. Individuals' sense of coherence can be seen as a coping resource in managing stressors. A cross-sectional study design was used. One year post-myocardial infarction, a total of 74 patients still experiencing fatigue completed four questionnaires: the Multidimensional Fatigue Scale Inventory-20, the Brief Illness Perception Questionnaire, the Sense of Coherence scale (sense of coherence-13) and a single-item measure of stress symptoms. Descriptive statistics, correlations and stepwise regression analysis were carried out. Strong negative associations were found between illness perceptions of fatigue, sense of coherence and stress. Sense of coherence has an impact on illness perceptions of fatigue. Of the dimensions of sense of coherence, comprehensibility seemed to play the greatest role in explaining illness perceptions of fatigue one year after myocardial infarction. To strengthen patients' coping resources, health-care professionals should create opportunities for patients to gain individual-level knowledge that allows them to distinguish between common fatigue symptoms and warning signs for myocardial infarction. There is a need to improve strategies for coping with fatigue. It is also essential to identify patients with fatigue after myocardial infarction, as they need explanations for their symptoms and extra support. © 2016 John Wiley & Sons Ltd.

Correlation of an abnormal rest /sup 201/Tl myocardial image: Pathological findings in cardiac transplant recipients

Energy Technology Data Exchange (ETDEWEB)

McKillop, J.H.; McDougall, I.R.; Billingham, M.; Schroeder, J.S.

1982-06-01

Rest myocardial /sup 201/Tl scintigraphy was undertaken in 15 males mean age 39 years (22-54) who had been accepted for cardiac transplantation. Complete pathological correlation was obtained in 14 after transplantation and in 1 who died before a suitable donor heart became available. The average time from scintigraphy to pathological evaluation was 42 days (9-103). All the /sup 201/Tl images were grossly abnormal and on the basis of these studies it was not possible to differentiate ischemic from idiopathic cardiomyopathy. Each of the three views of the /sup 201/Tl study was divided into three segments, therefore 135 areas were available for comparison (3 x 3 x 15). Eighty-eight of these were abnormal on scan and 78 of these were abnormal pathologically. The right ventricle was seen on all rest images but the degree of uptake bore no relationship to the measured thickness of the right ventricular wall. Structures such as the atrial wall and the enlarged papillary muscle were visualized in some patients. In two patients there was an improvement of the rest /sup 201/Tl image in delayed views and histologically these areas showed a mixture of muscle and fibrous tissue. The sensitivity of /sup 201/Tl imaging in this study was 89% and there was close correlation of the images with gross and microscopic pathological findings.

Evaluation of the prevalence of stress and its phases in acute myocardial infarction in patients active in the labor market

Directory of Open Access Journals (Sweden)

Luciane Boreki Lucinda

2015-02-01

Full Text Available Introduction: Acute myocardial infarction is a social health problem of epidemiological relevance, with high levels of morbidity and mortality. Stress is one of the modifiable risk factors that triggers acute myocardial infarction. Stress is a result of a set of physiological reactions, which when exaggerated in intensity or duration can lead to imbalances in one's organism, resulting in vulnerability to diseases. Objective: To identify the presence of stress and its phases in hospitalized and active labor market patients with unstable myocardial infarction and observe its correlation with the life of this population with stress. Methods: The methodology used was a quantitative, descriptive and transversal research approach conducted with a total of 43 patients, who were still active in the labor market, presenting or not morbidities. Data collection occurred on the fourth day of their hospitalization and patients responded to Lipp's Stress Symptom Inventory for adults. Results: Thirty-one patients (72.1% presented stress and twelve (27.8% did not. In patients with stress, the identified phases were: alert - one patient (3.2%; resistance -twenty-two patients (71.0%; quasi-exhaustion - six patients (19.4% and exhaustion - two patients (6.5%. All women researched presented stress. Conclusion: The results suggest a high level of stress, especially in the resistance phase, in the male infarcted population, hospitalized and active in the labor market.

IL-23 Promotes Myocardial I/R Injury by Increasing the Inflammatory Responses and Oxidative Stress Reactions

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Xiaorong Hu

2016-05-01

Full Text Available Background/Aims: Inflammation and oxidative stress play an important role in myocardial ischemia and reperfusion (I/R injury. We hypothesized that IL-23, a pro-inflammatory cytokine, could promote myocardial I/R injury by increasing the inflammatory response and oxidative stress. Methods: Male Sprague-Dawley rats were randomly assigned into sham operated control (SO group, ischemia and reperfusion (I/R group, (IL-23 + I/R group and (anti-IL-23 + I/R group. At 4 h after reperfusion, the serum concentration of lactate dehydrogenase (LDH, creatine kinase (CK and the tissue MDA concentration and SOD activity were measured. The infarcte size was measured by TTC staining. Apoptosis in heart sections were measured by TUNEL staining. The expression of HMGB1 and IL-17A were detected by Western Blotting and the expression of TNF-α and IL-6 were detected by Elisa. Results: After 4 h reperfusion, compared with the I/R group, IL-23 significantly increased the infarct size, the apoptosis of cardiomyocytes and the levels of LDH and CK (all P 0.05. All these effects were abolished by anti-IL-23 administration. Conclusion: The present study suggested that IL-23 may promote myocardial I/R injury by increasing the inflammatory responses and oxidative stress reaction.

Oxidative stress and myocardial dysfunction in young rabbits after short term anabolic steroids administration.

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Germanakis, Ioannis; Tsarouhas, Konstantinos; Fragkiadaki, Persefoni; Tsitsimpikou, Christina; Goutzourelas, Nikolaos; Champsas, Maria Christakis; Stagos, Demetrios; Rentoukas, Elias; Tsatsakis, Aristidis M

2013-11-01

The present study focuses on the short term effects of repeated low level administration of turinabol and methanabol on cardiac function in young rabbits (4 months-old). The experimental scheme consisted of two oral administration periods, lasting 1 month each, interrupted by 1-month wash-out period. Serial echocardiographic evaluation at the end of all three experimental periods was performed in all animals. Oxidative stress markers have also been monitored at the end of each administration period. Treated animals originally showed significantly increased myocardial mass and systolic cardiac output, which normalized at the end of the wash out period. Re-administration led to increased cardiac output, at the cost though of a progressive myocardial mass reduction. A dose-dependent trend towards impaired longitudinal systolic, diastolic and global myocardial function was also observed. The adverse effects were more pronounced in the methanabol group. For both anabolic steroids studied, the low dose had no significant effects on oxidative stress markers monitored, while the high dose created a hostile oxidative environment. In conclusion, anabolic administration has been found to create a possible deleterious long term effect on the growth of the immature heart and should be strongly discouraged especially in young human subjects. Copyright © 2013 Elsevier Ltd. All rights reserved.

Interpretative intra- and interobserver reproducibility of Stress/Rest 99m Tc-steamboat's myocardial perfusion SPECT using semi quantitative 20-segment model

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Fazeli, M.; Firoozi, F.

2002-01-01

It well established that myocardial perfusion SPECT with 201 T L or 99 mTc-se sta mi bi play an important role diagnosis and risk assessment in patients with known or suspected coronary artery disease. Both quantitative and qualitative methods are available for interpretation of images. The use of a semi quantitative scoring system in which each of 20 segments is scored according to a five-point scheme provides an approach to interpretation that is more systematic and reproducible than simple qualitative evaluation. Only a limited number of studies have dealt with the interpretive observer reproducibility of 99 mTc-steamboat's myocardial perfusion imaging. The aim of this study was to assess the intra-and inter observer variability of semi quantitative SPECT performed with this technique. Among 789 patients that underwent myocardial perfusion SPECT during last year 80 patients finally need to coronary angiography as gold standard. In this group of patients a semi quantitative visual interpretation was carried out using short axis and vertical long-axis myocardial tomograms and a 20-segments model. These segments we reassigned on six evenly spaced regions in the apical, mid-ventricular, and basal short-axis view and two apical segments on the mid-ventricular long-axis slice. Uptake in each segment was graded on a 5-point scale (0=normal, 1=equivocal, 2=moderate, 3=severe, 4=absence of uptake). The steamboat's images was interpreted separately w ice by two observers without knowledge of each other's findings or results of angiography. A SPECT study was judged abnormal if there were two or more segments with a stress score equal or more than 2. We con eluded that semi-quantitative visual analysis is a simple and reproducible method of interpretation

Dobutamine cardiovascular magnetic resonance for the detection of myocardial ischemia with the use of myocardial tagging.

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Kuijpers, Dirkjan; Ho, Kai Yiu J A M; van Dijkman, Paul R M; Vliegenthart, Rozemarijn; Oudkerk, Matthijs

2003-04-01

The purpose of this study was to assess the value of high-dose dobutamine cardiovascular magnetic resonance (CMR) with myocardial tagging for the detection of wall motion abnormalities as a measure of myocardial ischemia in patients with known or suspected coronary artery disease. Two hundred eleven consecutive patients with chest pain underwent dobutamine-CMR 4 days after antianginal medication was stopped. Dobutamine-CMR was performed at rest and during increasing doses of dobutamine. Cine-images were acquired during breath-hold with and without myocardial tagging at 3 short-axis levels. Regional wall motion was assessed in a 16-segment short-axis model. Patients with new wall motion abnormalities (NWMA) were examined by coronary angiography. Dobutamine-CMR was successfully performed in 194 patients. Dobutamine-CMR without tagging detected NWMA in 58 patients, whereas NWMA were detected in 68 patients with tagging (P=0.002, McNemar). Coronary angiography showed coronary artery disease in 65 (96%) of these 68 patients. All but 3 of the 65 patients needed revascularization. In the 112 patients with a negative dobutamine-CMR study, without baseline wall motion abnormalities, the cardiovascular occurrence-free survival rate was 98.2% during the mean follow-up period of 17.3 months (range, 7 to 31). Dobutamine-CMR with myocardial tagging detected more NWMA compared with dobutamine-CMR without tagging and reliably separated patients with a normal life expectancy from those at increased risk of major adverse cardiac events.

Association between abnormal myocardial fatty acid metabolism and cardiac-derived death among patients undergoing hemodialysis: results from a cohort study in Japan.

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Moroi, Masao; Tamaki, Nagara; Nishimura, Masato; Haze, Kazuo; Nishimura, Tsunehiko; Kusano, Eiji; Akiba, Takashi; Sugimoto, Tokuichiro; Hase, Hiroki; Hara, Kazuhiro; Nakata, Tomoaki; Kumita, Shinichiro; Nagai, Yoji; Hashimoto, Akiyoshi; Momose, Mitsuru; Miyakoda, Keiko; Hasebe, Naoyuki; Kikuchi, Kenjiro

2013-03-01

Detecting myocardial ischemia in hemodialysis patients is crucial given the high incidence of silent ischemia and the high cardiovascular mortality rates. Abnormal myocardial fatty acid metabolism as determined by imaging with (123)I-labeled BMIPP (β-methyl iodophenyl-pentadecanoic acid) might be associated with cardiac-derived death in hemodialysis patients. Prospective observational study. Asymptomatic hemodialysis patients with one or more cardiovascular risk factors, but without known coronary artery disease, were followed up for 3 years at 48 Japanese hospitals (406 men, 271 women; mean age, 64 years). Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4). Cardiac-derived death, including cardiac and sudden death. HRs were estimated using a Cox model for associations between BMIPP summed scores and cardiac-derived death, adjusting for potential confounders of age, sex, body mass index, dialysis duration, and cardiovascular risk factors. Rates of all-cause mortality and cardiac-derived death were 18.5% and 6.8%, respectively. Cardiac-derived death (acute myocardial infarction [n = 10], congestive heart failure [n = 13], arrhythmia [n = 2], valvular heart disease [n = 1], and sudden death [n = 20]) accounted for 36.8% of all-cause deaths. Cardiac-derived death (n = 46) was associated with age, history of heart failure, and BMIPP summed scores of 4 or higher (HR, 2.9; P death-free survival rates were 95.7%, 90.6%, and 78.8% when BMIPP summed scores were 3 or lower, 4-8, and 9 or higher, respectively. BMIPP summed score also was a predictor of all-cause death (HR, 1.6; P = 0.009). Sudden death of unknown cause was considered to have been cardiac derived, although a coronary origin was not confirmed. Abnormal myocardial fatty acid metabolism is associated with cardiac-derived death in hemodialysis patients. BMIPP single-proton emission computed tomography appears clinically useful for predicting cardiac-derived death

Cognitive abnormalities and neural mechanisms in post-traumatic stress disorder

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Ting HU

2017-10-01

Full Text Available Post-traumatic stress disorder (PTSD is an anxiety disorder that develops usually in response to an overwhelmingly terrifying or a life-threatening event. The symptoms including intrusion, flashback, re-experiencing, hyperarousal and avoidance can seriously impair the cognitive functions. At present, the researches have found PTSD patients had the difficulty in retrieving autobiographical memory and narrative disorder, attention bias toward traumatic stimulus and intellectual decline. Decrease in hippocampus and amygdala's volumes, excess endoplasmic reticulum stress, medial prefrontal cortex's low activation and highly excited response of the amygdala to the traumatic stimulus may be the neural mechanisms of cognitive abnormalities. In- depth research on cognitive abnormalities provides directions for PTSD prevention and treatment, and the cognitive treatment by prolonged exposure and attention control may be the effective method. DOI: 10.11855/j.issn.0577-7402.2017.09.14

Characteristic findings of exercise ECG test, perfusion SPECT and coronary angiography in patients with exercise induced myocardial stunning

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Ahn, Byeong Cheol; Seo, Ji Hyoung; Bae, Jin Ho; Jeong, Shin Young; Park, Hun Sik; Lee, Jae Tae; Chae, Shung Chull; Lee, Kyu Bo [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

2004-06-01

Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV ejection fraction (LVEF) was {>=}5% lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1% (non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs 9.2%, p=0.029; severity 13.5 vs 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis(80{approx}99%) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than

Abnormal stress responsivity in a rodent developmental disruption model of schizophrenia.

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Zimmerman, Eric C; Bellaire, Mark; Ewing, Samuel G; Grace, Anthony A

2013-10-01

Although numerous studies have implicated stress in the pathophysiology of schizophrenia, less is known about how the effects of stress interact with genetic, developmental, and/or environmental determinants to promote disease progression. In particular, it has been proposed that in humans, stress exposure in adolescence could combine with a predisposition towards increased stress sensitivity, leading to prodromal symptoms and eventually psychosis. However, the neurobiological substrates for this interaction are not fully characterized. Previous work in our lab has demonstrated that rats born to dams administered with the DNA-methylating agent methylazoxymethanol acetate (MAM) at gestational day 17 exhibit as adults behavioral and anatomical abnormalities consistent with those observed in patients with schizophrenia. Here, we examined behavioral and neuroendocrine responses to stress in the MAM model of schizophrenia. MAM-treated male rats were exposed to acute and repeated footshock stress at prepubertal, peripubteral, and adult ages. Ultrasonic vocalizations (USVs), freezing, and corticosterone responses were quantified. We found that juvenile MAM-treated rats emitted significantly more calls, spent more time vocalizing, emitted calls at a higher rate, and showed more freezing in response to acute footshock stress when compared with their saline (SAL) treated counterparts, and that this difference is not present in older animals. In addition, adolescent MAM-treated animals displayed a blunted HPA axis corticosterone response to acute footshock that did not adapt after 10 days of stress exposure. These data demonstrate abnormal stress responsivity in the MAM model of schizophrenia and suggest that these animals are more sensitive to the effects of stress in youth.

Oxidative-Nitrosative Stress and Myocardial Dysfunctions in Sepsis: Evidence from the Literature and Postmortem Observations

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M. Neri

2016-01-01

Full Text Available Background. Myocardial depression in sepsis is common, and it is associated with higher mortality. In recent years, the hypothesis that the myocardial dysfunction during sepsis could be mediated by ischemia related to decreased coronary blood flow waned and a complex mechanism was invoked to explain cardiac dysfunction in sepsis. Oxidative stress unbalance is thought to play a critical role in the pathogenesis of cardiac impairment in septic patients. Aim. In this paper, we review the current literature regarding the pathophysiology of cardiac dysfunction in sepsis, focusing on the possible role of oxidative-nitrosative stress unbalance and mitochondria dysfunction. We discuss these mechanisms within the broad scenario of cardiac involvement in sepsis. Conclusions. Findings from the current literature broaden our understanding of the role of oxidative and nitrosative stress unbalance in the pathophysiology of cardiac dysfunction in sepsis, thus contributing to the establishment of a relationship between these settings and the occurrence of oxidative stress. The complex pathogenesis of septic cardiac failure may explain why, despite the therapeutic strategies, sepsis remains a big clinical challenge for effectively managing the disease to minimize mortality, leading to consideration of the potential therapeutic effects of antioxidant agents.

Is myocardial fatty acid metabolism different between hypertrophic cardiomyopathy and hypertensive hypertrophy?

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Narita, Michihiro; Kurihara, Tadashi; Usami, Masahisa; Honda, Minoru

1994-01-01

To investigate characteristics of fatty acid metabolism in hypertrophic cardiomyopathy (HCM), we performed myocardial imaging with 123 I-iodophenyl-3-methylpentadecanoic acid (BMIPP) in 24 HCM patients, 13 patients with hypertensive hypertrophy (HT) and 10 normal subjects. Rest myocardial imaging with 123 I-BMIPP was obtained at 20 minutes and 3 hours after 123 I-BMIPP injection. Rest 201 Tl imaging was also performed. In addition to ordinary tomography, whole body imaging was performed to calculate %Uptake (percentage of cardiac uptake of the isotope to total injected dose). As global indexes of fatty acid metabolism, we calculated two parameters; Uptake Ratio (%Uptake of 123 I-BMIPP normalized by myocardial perfusion) and WOR (percent reduction of myocardial 123 I-BMIPP within 3 hours). Regional abnormality was evaluated by visual assessment of ordinary tomograms and by BMIPP/Tl map. BMIPP/Tl map was made from Bull's-eye maps of 123 I-BMIPP and 201 Tl, and it represented 123 I-BMIPP uptake normalized by myocardial perfusion of each pixel which constructed the image. %Uptake of 123 I-BMIPP was not different among three groups. Uptake Ratio was significantly (p HT (1.03±0.08)>HCM (0.87±0.09). WOR of 123 I-BMIPP was accerelated in HCM (12.7±4.7%) and HT (10.2±2.9%) compared with normal (5.1±3.1%) (p 123 I-BMIPP distribution was found in 17 of 24 patients (71%) including 3 patients with equivocal abnormality. In HT patients, only equivocal abnormality was observed in 23%. In BMIPP/Tl map, abnormality was observed in 92% of HCM and 8% of HT. Although global myocardial fatty acid metabolism was equally disturbed both in HCM and HT, regional abnormality of fatty acid metabolism was observed preferetially in HCM. This indicated myocardial fatty acid metabolism was not identical between HCM and HT. (author)

Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block

International Nuclear Information System (INIS)

Falcao, Andrea; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares Junior, Jose; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto; Meneghetti, Jose C.

2015-01-01

Objectives: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. Objective: we sought to investigate rubidium-82 ( 82 Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. Methods: thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82 Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82 Rb-positron emission tomography studies and without left bundle branch block (GII). Results: stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p>0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). Conclusion: the data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82 Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients

Prognostic value of stress 99Tcm-MIBI myocardial perfusion SPECT after acute myocardial infarction

International Nuclear Information System (INIS)

Sui Xutao; Chen Zhi; Gao Shenghai; Shen Li; Li Shang'ai

2003-01-01

Objective: To investigate relativity of acute myocardial infarction (AMI) with clinical, stress test and perfusion imaging parameters and to assess predictive value on hard events of cardiac death or recurrent nonfatal AMI. Methods: One hundred and one patients of AMI underwent stress 99 Tc m -MIBI SPECT before discharge. Hard and soft events were followed-up, relative factors with cardiac events were analyzed by statistical methods and predictive value on hard events were assessed. Results: Independent predictors by multivariate analysis for cardiac hard events or all cardiac events consisted of a history of prior AMI (RR=5.30, CI 2.17-12.98), a low exercise capacity (RR=6.28, CI 1.92-21.46) and left ventricular ejection fraction 99 Tc m -MIBI SPECT is a single test that can provide exercise parameter, cardiac perfusion imaging information and left ventricular function assessment to identify high-risk and estimate hard prognosis at discharge of AMI patients. These high-risk patients can be referred for early invasive evaluation and intervention

Simultaneous dual-radionuclide myocardial perfusion imaging with a solid-state dedicated cardiac camera.

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Ben-Haim, Simona; Kacperski, Krzysztof; Hain, Sharon; Van Gramberg, Dean; Hutton, Brian F; Erlandsson, Kjell; Sharir, Tali; Roth, Nathaniel; Waddington, Wendy A; Berman, Daniel S; Ell, Peter J

2010-08-01

We compared simultaneous dual-radionuclide (DR) stress and rest myocardial perfusion imaging (MPI) with a novel solid-state cardiac camera and a conventional SPECT camera with separate stress and rest acquisitions. Of 27 consecutive patients recruited, 24 (64.5+/-11.8 years of age, 16 men) were injected with 74 MBq of (201)Tl (rest) and 250 MBq (99m)Tc-MIBI (stress). Conventional MPI acquisition times for stress and rest are 21 min and 16 min, respectively. Rest (201)Tl for 6 min and simultaneous DR 15-min list mode gated scans were performed on a D-SPECT cardiac scanner. In 11 patients DR D-SPECT was performed first and in 13 patients conventional stress (99m)Tc-MIBI SPECT imaging was performed followed by DR D-SPECT. The DR D-SPECT data were processed using a spill-over and scatter correction method. DR D-SPECT images were compared with rest (201)Tl D-SPECT and with conventional SPECT images by visual analysis employing the 17-segment model and a five-point scale (0 normal, 4 absent) to calculate the summed stress and rest scores. Image quality was assessed on a four-point scale (1 poor, 4 very good) and gut activity was assessed on a four-point scale (0 none, 3 high). Conventional MPI studies were abnormal at stress in 17 patients and at rest in 9 patients. In the 17 abnormal stress studies DR D-SPECT MPI showed 113 abnormal segments and conventional MPI showed 93 abnormal segments. In the nine abnormal rest studies DR D-SPECT showed 45 abnormal segments and conventional MPI showed 48 abnormal segments. The summed stress and rest scores on conventional SPECT and DR D-SPECT were highly correlated (r=0.9790 and 0.9694, respectively). The summed scores of rest (201)Tl D-SPECT and DR-DSPECT were also highly correlated (r=0.9968, pstress perfusion defects were significantly larger on stress DR D-SPECT images, and five of these patients were imaged earlier by D-SPECT than by conventional SPECT. Fast and high-quality simultaneous DR MPI is feasible with D-SPECT in a

Myocardial imaging with 201Tl at rest and during exercise. Comparison with coronary arteriography and resting and stress electrocardiography

International Nuclear Information System (INIS)

Ritchie, J.L.; Trobaugh, G.B.; Hamilton, G.W.; Gould, K.L.; Narahara, K.A.; Murray, J.A.; Williams, D.L.

1977-01-01

Myocardial imaging with intravenous thallium-201 ( 201 Tl) was performed at rest and following maximal treadmill exercise in 101 patients with suspected coronary artery disease. Results were interpreted from Polaroid scintiphotos by three independent observers with complete interobserver agreement in 79%. Of 25 patients with no or insignificant coronary artery disease ( 201 Tl image defect, one (4%) had an exercise 201 Tl defect, none had an ECG Q wave, and four (16%) had exercise ST-segment depression. Among 76 patients with coronary artery disease (greater than or equal to 50% diameter stenosis), 58 (76%) had a defect on either the rest or exercise 201 Tl image. The proportion of patients with an exercise image defect (50/76, 66%) was greater than the proportion with exercise ST depression alone (34/76, 45%; P 201 Tl is easily accomplished with readily available imaging equipment. The image data enhanced the diagnostic sensitivity of stress electrocardiography, and provided spatial identification of the abnormal segment(s) of myocardium

Comparison of adenosine and exercise stress 201Tl myocardial perfusion imaging for diagnosing coronary heart disease in women

International Nuclear Information System (INIS)

Li Jiangjin; Ma Shuren; Meng Tao; Bao Zhi; Cui Jianhe

2011-01-01

Objective: To compare the diagnostic value of adenosine and exercise stress myocardial perfusion imaging (MPI) for detecting coronary heart disease (CHD) in women. Methods: One hundred and thirty-eight patients with CHD were randomly divided into two groups: adenosine stress group (n=69)and exercise stress group (n=69). All patients underwent myocardial SPECT evaluation. Coronary angiography (CAG), referred as 'gold standard' , was performed in each patient within 1 week before or after MPI. The diagnostic value of the two stress MPI was compared with χ 2 test or Fisher's exact test. Results: In adenosine stress group, the sensitivity, negative predictive value and accuracy were 88.2% (45/51), 72.7% (16/22), 88.4% (61/69), respectively, which were not significantly different from those of the exercise stress group (91.7% (44/48), 66.7% (8/12), 81.2% (52/64); χ 2 =0.571, 0.714, 0.249, P>0.05). However, the false positive rate of adenosine stress (11.1%, 2/18) was significantly lower than that of exercise stress (50.0%, 8/16), P=0.023. Conclusions: Adenosine and exercise stress MPI have similar value for CHD diagnosis in women, however, adenosine stress MPI may have an advantage of low false positive rate. (authors)

Myocardial blood flow assessment with {sup 82}rubidium-PET imaging in patients with left bundle branch block

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Falcao, Andrea; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares Junior, Jose; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto; Meneghetti, Jose C., E-mail: andrea.falcao@incor.usp.br [Universidade de Sao Paulo (InCor/USP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Instituto do Coracao

2015-11-15

Objectives: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. Objective: we sought to investigate rubidium-82 ({sup 82}Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. Methods: thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress {sup 82}Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal {sup 82}Rb-positron emission tomography studies and without left bundle branch block (GII). Results: stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p>0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). Conclusion: the data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by {sup 82}Rb-positron emission tomography imaging may be useful in identifying coronary artery

Assessment of myocardial viability in patients with myocardial infarction using twenty-four hour thallium-201 late redistribution imaging

International Nuclear Information System (INIS)

Yang Xiangjun; He Yongming; Zhang Bin; Wu Yiwei; Hui Jie; Jiang Tingbo; Song Jianping; Liu Zhihua; Jiang Wenping

2006-01-01

Rest thallium-201 ( 201 Tl) myocardial perfusion imaging has been widely used for evaluation of myocardial ischemia/viability after myocardial infarction, but the ideal timing for imaging after injection to maximally estimate viability is not well established. Thirty-six patients with myocardial infarction underwent the initial, 3 h, and 24 h redistribution imaging after intravenous injection of 148-185 MBq 201 Tl. The initial and 3 h images, the initial and 24 h images, and the 3 and 24 h images were compared double-blinded. Out of the 184 abnormal segments based on the initial imaging, 56 (30%) segments improved by at least 1 grade on the 3 h imaging while 78 (42%) segments improved by at least 1 grade on the 24 h imaging. The 24 h late imaging detected more viable myocardium than the 3 h imaging did, with a significant difference (χ 2 =5.680, p=0.017). There were 158 abnormal segments on the 3 h imaging, with average 28% (44) segments improved by at least 1 grade on the 24 h imaging. There were 128 initial abnormal segments with no improvement on the 3 h imaging. Out of these segments, the 24 h late redistribution imaging detected additional redistribution in 26 segments, taking up 20%. Twenty-four hour late 201 Tl imaging will demonstrated additional redistribution in patients who have incompletely reversible defects on early redistribution imaging at 3 h. (author)

Evaluation of myocardial involvement in Duchenne's progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

International Nuclear Information System (INIS)

Kawai, Naoki; Sotobata, Iwao; Okada, Mitsuhiro

1985-01-01

Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. A qualitative analysis was performed from five projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in the LV posterolateral or posterior wall (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle involvements or thoracic deformities assessed by transmission computed tomography. Extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. Progression of the myocardial scintigraphic abnormalities were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies over 2 to 3 years. It was concluded that thallium myocardial perfusion imaging is a useful clinical technique to assess myocardial involvement in Duchenne's progressive muscular dystrophy. (author)

Prognostic value of normal stress-only myocardial perfusion imaging: a comparison between conventional and CZT-based SPECT

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Yokota, Shu; Ottervanger, Jan Paul; Timmer, Jorik R. [Isala Hospital, Department of Cardiology, Zwolle (Netherlands); Mouden, Mohamed; Engbers, Elsemiek [Isala Hospital, Department of Cardiology, Zwolle (Netherlands); Isala Hospital, Department of Nuclear Medicine, Zwolle (Netherlands); Knollema, Siert; Jager, Pieter L. [Isala Hospital, Department of Nuclear Medicine, Zwolle (Netherlands)

2016-02-15

Single photon emission computed tomography (SPECT) myocardial perfusion imaging has proven to have prognostic importance in patients with suspected stable coronary artery disease (CAD). The recently introduced ultrafast cadmium zinc telluride (CZT)-based gamma cameras have been associated with less equivocal findings and more normal interpretations, allowing stress-only imaging to be performed more often. However, it is yet unclear whether normal stress-only CZT SPECT has comparable prognostic value as normally interpreted stress-only conventional SPECT. The study population consisted of 1,650 consecutive patients without known CAD with normal stress-only myocardial perfusion results with either conventional (n = 362) or CZT SPECT (n = 1,288). The incidence of major adverse cardiac events (MACE, all-cause death, non-fatal myocardial infarction and/or coronary revascularization) was compared between the conventional SPECT and CZT SPECT groups. Multivariable analyses using the Cox model were used to adjust for differences in baseline variables. Patients scanned with CZT were less often male (33 vs 39 %), had less often hypercholesterolaemia (41 vs 50 %) and had more often a family history of CAD (57 vs 49 %). At a median follow-up time of 37 months (interquartile range 28-45 months) MACE occurred in 68 patients. The incidence of MACE was 1.5 %/year in the CZT group, compared to 2.0 %/year in the conventional group (p = 0.08). After multivariate analyses, there was a trend to a lower incidence of MACE in the CZT SPECT group (hazard ratio 0.61, 95 % confidence interval 0.35-1.04, p = 0.07). The prognostic value of normal stress-only CZT SPECT is at least comparable and may be even better than that of normal conventional stress SPECT. (orig.)

Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events

DEFF Research Database (Denmark)

Chen, Marcus Y.; Rochitte, Carlos E.; Arbab-Zadeh, Armin

2017-01-01

Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial p...

Normal stress databases in myocardial perfusion scintigraphy – how many subjects do you need?

DEFF Research Database (Denmark)

Trägårdh, Elin; Sjöstrand, Karl; Edenbrandt, Lars

2012-01-01

) for male, NC for female, attenuation‐corrected images (AC) for male and AC for female subjects. 126 male and 205 female subjects were included. The normal database was created by alternatingly computing the mean of all normal subjects and normalizing the subjects with respect to this mean, until...... convergence. Coefficients of variation (CV) were created for increasing number of included patients in the four different normal stress databases. Normal stress databases with ...Commercial normal stress databases in myocardial perfusion scintigraphy (MPS) commonly consist of 30–40 individuals. The aim of the study was to determine how many subjects are needed. Four normal stress databases were developed using patients who underwent 99mTc MPS: non‐corrected images (NC...

Asymmetrically thickened posterior wall is associated with decline of ejection fraction after stress on adenosine stress/rest thallium-201 gated myocardial SPECT

Energy Technology Data Exchange (ETDEWEB)

Kim, Bom Sahn; Lee, Won Woo; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

2004-07-01

LV parameters (LVEF. ESVI and EDVI) on adenosine stress/rest thallium-201 gated myocardial SPECT (gSPECT) are various from stress to rest. We investigated the reason why they were various in patients without coronary artery disease. Seventy-one patients(M:F=32:39, age 58.1{+-}9.7yrs), who underwent gSPECT and coronary angiography (CAG) due to chest pain or preoperative evaluation were included. CAG results were normal or insignificant. Exclusion criteria were atrial fibrillation, thyroid disease, primary cardiomyopathy, myocardial bridge, LBBB, MI, and valvular heart disease. Patients were calssified into 3 groups by EF difference ({delta}EF=rest-stress EF) on gSPECT : group1 ({delta}EF{>=}10), group2 (0 {<=}{delta}EF<10), and group3 ({delta}EF<0). LV parameters on gSPECT and thicknesses of IVS (interventricular septum) and LVPW (left ventricular posterior wall) on echocardiography were compared among the 3 groups. Myocardial perfusion status were normal or mild reversible/persistent perfusion defect in 76.1% (54/71). LVEFs at stress were not different among all 3 groups : 59.3{+-}8.54% in group 1 (61.3{+-}10.22% in group 2 and 64.8{+-}7.58% in group 3 (p>0.05). But LVEF at rest was smaller in group 3 (58.7{+-}8.38%) than the other groups (72.5{+-}8.77% in group1 and 66.7{+-}10.6% in group2) (p<0.01). EDVIs and ESVI at stress were larger than those at rest in all groups (p<0.05) except ESVI in group 3 (16.2{+-}6.21ml at stress and 17.5{+-}6.41ml at rest, p<0.01), and that was attributed to EF<0 in group 3. In echocardiographical analysis, group 3 had significantly increased wall thickness of LVPW (10.7{+-}1.2mm versus 9.4{+-}1.6mm, p=0.01) and decreased wall thickness ratio of IVS/LVPW (0.963{+-}0.102 versus 1.048{+-}0.104, p=0.035) than group 1. In patients without coronary artery disease, LVEF, EDVI and ESVI on gSPECT were various and decline of LVEF from stress to rest was caused by unnormalized ESVI . Asymmetrically thickened LVPW may play a crucial role and

Asymptomatic myocardial ischemia following cold provocation

International Nuclear Information System (INIS)

Shea, M.J.; Deanfield, J.E.; deLandsheere, C.M.; Wilson, R.A.; Kensett, M.; Selwyn, A.P.

1987-01-01

Cold is thought to provoke angina in patients with coronary disease either by an increase in myocardial demand or an increase in coronary vascular resistance. We investigated and compared the effects of cold pressor stimulation and symptom-limited supine bicycle exercise on regional myocardial perfusion in 35 patients with stable angina and coronary disease and in 10 normal subjects. Regional myocardial perfusion was assessed with positron emission tomography and rubidium-82. Following cold pressor stimulation 24 of 35 patients demonstrated significant abnormalities of regional myocardial perfusion with reduced cation uptake in affected regions of myocardium: 52 +/- 9 to 43 +/- 9 (p less than 0.001 vs normal subjects). Among these 24 patients only nine developed ST depression and only seven had angina. In contrast, 29 of 35 patients underwent supine exercise, and abnormal regional myocardial perfusion occurred in all 29, with a reduction in cation intake from 48 +/- 10 to 43 +/- 14 (p less than 0.001 vs normal subjects). Angina was present in 27 of 29 and ST depression in 25 of 29. Although the absolute decrease in cation uptake was somewhat greater following cold as opposed to exercise, the peak heart rate after cold was significantly lower than that after exercise (82 +/- 12 vs 108 +/- 16 bpm, p less than 0.05). Peak systolic blood pressures after cold and exercise were similar (159 +/- 24 vs 158 +/- 28). Thus, cold produces much more frequent asymptomatic disturbances of regional myocardial perfusion in patients with stable angina and coronary disease than is suggested by pain or ECG changes

Effects of perfusion detect on the measurement of left ventricular mass, ventricular volume and post-stress left ventricular ejection fraction in gated myocardial perfusion SPECT

International Nuclear Information System (INIS)

Ahn, Byeong Cheol; Bae, Sun Keun; Lee, Sang Woo; Jeong, Sin Young; Lee, Jae Tae; Lee, Kyu Bo

2002-01-01

The presence of perfusion defect may influence the left ventricular mass (LVM) measurement by quantitative gated myocardial perfusion SPECT (QGS), and ischemic myocardium, usually showing perfusion defect may produce post-stress LV dysfunction. This study was aimed to evaluated the effects of extent and reversibility of perfusion defect on the automatic measurement of LVM by QGS and to investigate the effect of reversibility of perfusion defect on post-stress LV dysfunction. Forty-six patients (male/female=34:12, mean age=64 years) with perfusion defect on myocardial perfusion SPECT underwent rest and post-stress QGS. Forty patients (87%) showed reversible defect. End-diastolic volume (EDV), end-systolic volume (ESV), LV ejection fraction (EF), and LV myocardial volume were obtained from QGS by autoquant program, and LVM was calculated by multiplying the LV myocardial volume by the specific gravity of myocardium. LVMs measured at rest and post-stress QGS showed good correlation, and higher correlation was founded in the subjects with fixed perfusion defect and with small defect (smaller than 20%). There were no significant differences in EDVs, ESVs and EFs between obtained by rest and post-stress QGS in patients with fixed myocardial defect. Whereas, EF obtained by post-stress QGS was lower than that by rest QGS in patients with reversible defect and 10 (25%) of them showed decreases in EF more than 5% in post-stress QGS, as compared to that of rest QGS. Excellent correlations of EDVs, ESVs, EFs between rest and post-stress QGS were noted. Patients with fixed defect had higher correlation between defect can affect LVM measurement by QGS and patients with reversible defect shows post-stress LV dysfunction more frequently than patients with fixed perfusion defect

Important parameters in the detection of left main trunk disease using stress myocardial perfusion imaging

International Nuclear Information System (INIS)

Shiba, Chie; Chikamori, Taishiro; Hida, Satoshi

2009-01-01

We sought noninvasively to diagnose left main trunk (LMT) disease using myocardial perfusion imaging (MPI). Five hundred and eight patients with suspected coronary artery disease (CAD) underwent both stress MPI and coronary angiography. The extent and severity of perfusion abnormalities were assessed using a 20-segment model. In addition, perfusion defects in both left anterior descending and left circumflex arterial territories were defined as a left main (LM) pattern defect, and those in 3-coronary arterial territories as a 3-vessel pattern defect. In 42 patients with LMT disease, a summed stress score (19.4±10.0 vs. 13.5±10.0; p<0.0001) and a summed rest score (12.1±9.7 vs. 7.0±7.8; p=0.002) were greater than in 466 patients without LMT disease, while a summed difference score was similar (7.3±7.7 vs. 6.5±6.1; p=NS). The prevalence of an LM-pattern defect was low in both groups (12% vs. 8%; p=NS). However, a 3-vessel pattern defect (33% vs. 7%; p<0.0001), lung uptake of radiotracers (38% vs. 11%; p<0.0001), and transient ischemic dilation (31% vs. 13%; p=0.003) were more frequently observed in patients with LMT disease than in those without. Logistic regression analysis showed that a 3-vessel pattern defect (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.8; p=0.007), lung uptake of radiotracers (OR=2.5, 95% CI=1.1-5.7; p=0.03), and previous myocardial infarction (MI) (OR=2.4, 95% CI=1.0-5.7; p=0.05) were the most important parameters to detect LMT disease. After excluding 163 patients with previous MI, a repeat analysis revealed that lung uptake of radiotracers (OR=8.2, 95% CI=2.3-29.2; p=0.001) and an LM-pattern defect (OR=6.3, 95% CI=1.4-27.2; p<0.02) were independent predictors for LMT disease. In the identification of LMT disease, lung uptake of radiotracers was a single best parameter, which was independent of the presence or absence of previous MI. (author)

Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis

Energy Technology Data Exchange (ETDEWEB)

Momose, Mitsuru; Kondo, Chisato; Kobayashi, Hideki; Kusakabe, Kiyoko [Tokyo Women' s Medical University, School of Medicine, Department of Radiology, Shinjuku-ku, Tokyo (Japan); Babazono, Tetsuya [Tokyo Women' s Medical University, School of Medicine, Diabetes Centre, Shinjuku-ku, Tokyo (Japan); Nakajima, Takatomo [Tokyo Women' s Medical University, School of Medicine, Department of Cardiology, Shinjuku-ku, Tokyo (Japan)

2009-08-15

Diabetic patients with chronic kidney disease (CKD) frequently develop cardiac events within several years of the initiation of haemodialysis. The present study assesses the prognostic significance of stress myocardial ECG-gated perfusion imaging (MPI) in patients with diabetic CKD requiring haemodialysis. Fifty-five asymptomatic patients with diabetic stage V CKD and no history of heart disease scheduled to start haemodialysis were enrolled in this study (56{+-}11 years old; 49 with type 2 diabetes mellitus). All patients underwent {sup 201}Tl stress ECG-gated MPI 1 month before or after the initiation of haemodialysis to assess myocardial involvement. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score (SSS) and summed difference scores (SDS). The patients were followed up for at least 2 years (42{+-}15 months) to determine coronary intervention (CI) and heart failure (HF) as soft events and acute myocardial infarction (AMI) and all causes of deaths as hard events. The frequencies of myocardial ischaemia, resting perfusion defects, low ejection fraction and left ventricular (LV) dilatation were 24,20,29 and 49%, respectively. Ten events (18%) developed during the follow-up period including four CI, one HF, one AMI and four sudden deaths. Multivariate Cox analysis selected SDS (p=0.0011) and haemoglobin A{sub 1c} (HbA{sub 1c}) (p=0.0076) as independent prognostic indicators for all events. Myocardial ischaemia, in addition to glycaemic control, is a strong prognostic marker for asymptomatic patients with diabetic CKD who are scheduled to start haemodialysis. Stress MPI is highly recommended for the management and therapeutic stratification of such patients. (orig.)

Usefulness and safety of dobutamine stress thallium myocardial scintigraphy

International Nuclear Information System (INIS)

Imai, Kamon; Araki, Yasushi; Horiuchi, Kouichi; Saito, Satoshi; Ozawa, Yukio; Yasugi, Tadao.

1993-01-01

Pharmaceutical stress test is performed for diagnosis of coronary artery disease in patients who can not perform exercise test. We studied whether high dose dobutamine stres test is useful and safe. Subjects consisted of 133 patients (pts) in dobutamine stress test and 45 pts in exercise test. Dobutamine stres test was initiated by 10 μg/kg/min, followed by 10 μ/gkg/min increment every 3 minutes. Maximal dobutamine dose was 40 μg/kg/min for 3 minutes. Endpoints of dobutamine stress were as follows: ST depression equal to or more than (≥) 0.2 mV: 30 pts, ≥75% predictive maximum heart rate: 20 pts, ≥20 mmHg systolic blood pressure fallen: 10 pts, 40 μg/kg/min for 3 minutes: 10 pts, chest pain: 7 pts, pressure rate product (PRP) ≥25,000: 1 pt. Side effects of dobutamine stress test were as follows: palpitation: 52%, arhythmia: 13%, angina and dyspnea: 7%, headache: 6%. These symptoms disappeared within 2 minutes. One patient, who underwent dobutamine test 2 days after PTCA, had myocardial infarction. At peak of dobutamine stress test, systolic blood pressure, heart rate and PRP were increased similar to exercise test. However, diastolic blood pressure was not changed. The concentration at peak of dobutamine was 25.5±7.8 μg/kg/min. The duration of dobutamine stress test was 7.3±2.3 minutes. The 65 patients (49%) need more than 20 μg/kg/min of dobutamine which was maximal loading dose in previous reports. For diagnosis of coronary artery disease, sensitivity was 91% (31/34) and specificity was 70% (7/10). From these data, high dose dobutamine stress test is useful and relatively safe stress method for diagnosis of coronary disease. This stress test would be performed in patients who cannot undergo exercise test. (author)

Detection of myocardial 123I-BMIPP distribution abnormality in patients with ischemic heart disease based on normal data file in Bull's-eye polar map

International Nuclear Information System (INIS)

Takahashi, Nobukazu; Ishida, Yoshio; Hirose, Yoshiaki; Kawano, Shigeo; Fukuoka, Syuji; Hayashida, Kohei; Takamiya, Makoto; Nonogi, Hiroshi

1995-01-01

Visual interpretation of 123 I-BMIPP (BMIPP) myocardial images has difficulties in detecting mild reduction in tracer uptake. We studied the significance of the objective assessment of myocardial BMIPP maldistributions at rest by using a Bull's-eye map and its normal data file for detecting ischemic heart disease. Twenty nine patients, 15 with prior myocardial infarction and 14 with effort angina were studied. The initial 15-min BMIPP image was evaluated by visual analysis and by generating the extent Bull's-eye map which exhibits regions with reduced % uptake under mean-2SD of 10 normal controls. The sensitivity for determining coronary lesions in non-infarcted myocardial regions with the extent map was superior to that with visual analysis (67% vs. 33%). In the regions supplied by the stenotic coronary artery, those which showed visually negative but positive in the map and which showed positive in both had higher incidence of wall motion abnormalities and severe coronary stenosis than those with normal findings in both. These results suggest that the objective assessment based on the normal data file in a Bull's-eye polar map is clinically important for improving the limitation or the visual interpretation in 123 I-BMIPP imaging. (author)

Cardiac MRI for myocardial ischemia.

LENUS (Irish Health Repository)

Daly, Caroline

2013-01-01

Proper assessment of the physiologic impact of coronary artery stenosis on the LV myocardium can affect patient prognosis and treatment decisions. Cardiac magnetic resonance imaging (CMR) assesses myocardial perfusion by imaging the myocardium during a first-pass transit of an intravenous gadolinium bolus, with spatial and temporal resolution substantially higher than nuclear myocardial perfusion imaging. Coupled with late gadolinium enhancement (LGE) imaging for infarction during the same imaging session, CMR with vasodilating stress perfusion imaging can qualitatively and quantitatively assess the myocardial extent of hypoperfusion from coronary stenosis independent of infarcted myocardium. This approach has been validated experimentally, and multiple clinical trials have established its diagnostic robustness when compared to stress single-photon emission computed tomography. In specialized centers, dobutamine stress CMR has been shown to have incremental diagnostic value above stress echocardiography due to its high imaging quality and ability to image the heart with no restriction of imaging window. This paper reviews the technical aspects, diagnostic utility, prognostic values, challenges to clinical adaptation, and future developments of stress CMR imaging.

Unexpected myocardial uptake on bone scintigraphy in an infant with Kawasaki disease

International Nuclear Information System (INIS)

Macdonald, W.B.G.; Troedson, R.G.

2003-01-01

Full text: A two-month-old female infant was admitted to hospital because of irritability and poor feeding over the preceding two weeks. There was no history of fever but serum inflammatory markers were elevated and a throat swab yielded a pure growth of Strep, pyogenes. There was no response to antibiotics. The nursing staff noted the infant disliked handling and skeletal pathology was suspected. A bone scan using Tc-99m hydroxymethylene diphosphonate (HDP) showed myocardial activity, with no evidence of abnormal skeletal activity. Subsequent echocardiography showed coronary artery ectasia, typical of Kawasaki disease, with papillary muscle dysfunction, indicating likely myocarditis. A diagnosis of myocarditis secondary to Kawasaki disease was made and the patient promptly improved following intravenous immunoglobulin therapy. Cardiac manifestations of Kawasaki disease included coronary artery aneurysms, myocardial infarction, regional perfusion abnormalities and myocarditis. Myocardial uptake of phosphate tracers is well known following myocardial infarction but there was no wall motion disturbance or ECG abnormality to suggest infarction in this patient and she was felt to have myocarditis. Myocardial uptake of phosphate tracers has not previously been reported in Kawasaki disease. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

Myocardial scintigraphy with thallium-201 and technetium-99m-hexakis-methoxyisobutylisonitrile in left bundle branch block: a study in patients with and without coronary artery disease

International Nuclear Information System (INIS)

Knapp, W.H.; Bentrup, A.; Schmidt, U.; Ohlmeier, H.; Bochum Univ. Hospital, Bad Oeynhausen

1993-01-01

In left bundle branch block (LBBB) thallium-201 myocardial scintigraphy frequently reveals septal abnormalities in the absence of coronary artery disease (CAD) and gives rise to 'false-positive' results in patients with suspected CAD. It has not yet been clarified which pathophysiological mechanism is responsible for these perfusion abnormalities. A total of 66 patients with constant LBBB were investigated with 201 Tl or technetium-99m-hexakis-methoxyisobutylisonitrile (MIBI), 62 underwent coronary angiography. Of 12 patients without left anterior descending artery (LAD) or right coronary artery (RCA) stenoses, 11 had a reversible septal activity deficit after 201 Tl stress injection, whereas 20 of 22 patients without relevant CAD showed a constant stress/rest septal deficit using MIBI. Regarding patients with significant LAD and/or RCA stenoses, both radio-pharmaceuticals almost always showed a 'reversible' septal deficit: With 201 Tl in 15 of 16 individuals and with MIBI in 14 of 15. In 12 patients 201 Tl was reinjected at rest. In those who had LAD or RCA stenoses (n=5), early septal activity uptake after stress injection was poorer than that after rest injection; in the absence of CAD (n=7), septal stress uptake corresponded with that of rest injection. It is concluded that septal perfusion abnormalities in LBBB and the absence of CAD are characterized by an exercise-independent reduction of septal blood flow per mass of viable myocardium and that stress/rest injection protocols of myocardial perfusion tracers are able to differentiate between LBBB with and without CAD. (orig.)

Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease.

Science.gov (United States)

Vaccarino, Viola; Wilmot, Kobina; Al Mheid, Ibhar; Ramadan, Ronnie; Pimple, Pratik; Shah, Amit J; Garcia, Ernest V; Nye, Jonathon; Ward, Laura; Hammadah, Muhammad; Kutner, Michael; Long, Qi; Bremner, J Douglas; Esteves, Fabio; Raggi, Paolo; Quyyumi, Arshed A

2016-08-24

Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress-induced myocardial ischemia (MSIMI). We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent (99m)Tc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more-adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Glutamatergic system abnormalities in posttraumatic stress disorder.

Science.gov (United States)

Nishi, Daisuke; Hashimoto, Kenji; Noguchi, Hiroko; Hamazaki, Kei; Hamazaki, Tomohito; Matsuoka, Yutaka

2015-12-01

Accumulating evidence suggests involvement of the glutamatergic system in the biological mechanisms of posttraumatic stress disorder (PTSD), but few studies have demonstrated an association between glutamatergic system abnormalities and PTSD diagnosis or severity. We aimed to examine whether abnormalities in serum glutamate and in the glutamine/glutamate ratio were associated with PTSD diagnosis and severity in severely injured patients at risk for PTSD and major depressive disorder (MDD). This is a nested case-control study in TPOP (Tachikawa project for prevention of posttraumatic stress disorder with polyunsaturated fatty acid) trial. Diagnosis and severity of PTSD were assessed 3 months after the accidents using the Clinician-Administered PTSD Scale. The associations of glutamate levels and the glutamine/glutamate ratio with diagnosis and severity of PTSD and MDD were investigated by univariate and multiple linear regression analyses. Ninety-seven of 110 participants (88 %) completed assessments at 3 months. Serum glutamate levels were significantly higher for participants with full or partial PTSD than for participants without PTSD (p = 0.049) and for participants with MDD than for participants without MDD (p = 0.048). Multiple linear regression analyses showed serum glutamate levels were significantly positively associated with PTSD severity (p = 0.02) and MDD severity (p = 0.03). The glutamine/glutamate ratio was also significantly inversely associated with PTSD severity (p = 0.03), but not with MDD severity (p = 0.07). These findings suggest that the glutamatergic system may play a major role in the pathogenesis of PTSD and the need for new treatments targeting the glutamatergic system to be developed for PTSD.

Role of stress myocardial perfusion SPECT scan in detection and management of coronary artery disease: Nairobi experience

International Nuclear Information System (INIS)

Makhdomi, K.B.; Warshow, M.M.; Patel, P.K.J.; Shah, D.; Githegi, D.R.M.

2002-01-01

Aim: Stress myocardial perfusion scans have acquired a significant role in the detection and management of Coronary Artery Disease. However, this mode of investigation has only recently been available in Nairobi, and this is the first such study from East Africa. We undertook a comparison of our results with that in the literature, to see whether they conformed to it. Materials and Methods: We performed a review of our initial 82 evaluable studies. The scans were performed with 99mTc-Tetrofosmin, using the single day stress-rest protocol with SPECT acquisitions. We carried out a correlation of our scan findings with angiographic data (where available), and clinical follow-up. The clinical end points where furnished by the referring physicians. We focused on myocardial infarction, need for re-vascularisation, and death. The mean clinical follow-up was 21.8 months (range of 12 months to 39 months). Results: Eighty (98%) of the studies revealed concordance with angiographic findings and/or were predictive of clinical outcome. Two studies were discordant, and will be discussed. The results are comparable with those in the literature. Conclusion: It is concluded that stress myocardial perfusion studies, done at our Centre, had a good predictive value, with regards to the presence and severity of disease, and correlated with the clinical outcome data

Clinical significance of increased lung/heart ratio in 210Tl stress myocardial image

International Nuclear Information System (INIS)

Liu Zaoli; Chang Fengqin; Zhang Fengge; Wang Xiaoyuan; Liu Liuhua

1990-01-01

230 cases were studied with 201 Tl stress image. The results showed that the lung/heart ratio closely correlated with the presence and severity of coronary heart disease (CHD). Among them, 18 cases (7.8%) showed significantly elevated lung/heart ratio (> 0.50). It was confirmed that all of the 18 cases have severe CHD with left ventricular insufficiency. The author emphasizes that measurement of the lung/heart ratio during 201 Tl stress myocardial image may be useful for the assessment of the severity, evalation of the left ventricular function and judgement of prognosis in CHD

Myocardial perfusion in patients with left bundle branch block and without coronary artery disease

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Honda, Minoru

1992-01-01

For the evaluation of myocardial perfusion in patients with left bundle branch block (LBBB), we performed exercise stress (Ex)-redistribution (RD) myocardial tomography with thallium-201 ( 201 Tl) in 23 patients with LBBB and without coronary artery disease (CAD). Myocardial images in patients with LBBB were compared with those of 9 patients with CAD who showed Ex induced transient septal defect. Bull'-eye maps ( 201 Tl distribution maps at Ex and RD and 201 Tl washout rate [WOR] map) were made from myocardial tomograms. In 23 patients with LBBB, 15 patients (65%) developed myocardial perfusion abnormality. In 10 (67%) of these 15 patients, transient perfusion defect appeared in the entire septum (diffuse type). On the other hand in 5 patients (33%), localized fixed perfusion defect developed at the boundary between septum and anterior wall (focal type). In focal type, every patient had other disease such as hypertension, aortic stenosis or sick sinus syndrome. While in patients with diffuse type, other diseases were observed in 30% (p 201 Tl WOR and 201 Tl uptake ratio of septum to lateral wall indicated that exercise induced septal defect was slighter in diffuse type than CAD. These points might be useful to differentiate whether CAD participates in the septal defect or not in patients with LBBB. (author)

Transient ischemic dilation ratio (TID) correlates with HbA1c in patients with diabetes type 2 with proven myocardial ischemia according to exercise myocardial SPECT

International Nuclear Information System (INIS)

Adamikova, A.; Rybka, J.; Bakala, J.; Bernatek, J.; Svacina, S.

2006-01-01

Abnormal values of the transient ischemic dilation ratio (TID) according to an exercise myocardial single photon emission computed tomography (SPECT) are linked to severe coronary artery disease. The authors investigated the relationship between TID and the levels of vascular cell adhesion molecule (VCAM), intercellular adhesion molecule (ICAM), E-selectin, microalbuminuria, intimamedia thickness and HbA 1c of diabetic subjects. We observed 38 subjects with diabetes type 2 (10 women, 28 men), of average age 56.08±8.24 years, with no past history of cardiovascular disease. All subjects were examined using an exercise myocardial SPECT. Transient ischemic dilation, summed stress score (SSS), summed rest score (SRS) and stress total severity score (STSS) were determined to quantify myocardial ischemia. The average IMT value was 1.05±0.31 mm. The TID value was 1.02±0.154, VCAM 795.24±163.25 mg/l, ICAM 516.55±164.07, E-selectin 63.82±38.89, HbA 1c 7.09±1.68%, microalbuminuria 68.01±55.21 mg/l. When ascertaining the relation of TID to the other factors we used Pearson's correlation at the level of significance p 1c (p=0.035); the other factors did not show any significant correlation. Diabetes and its long term unsatisfactory compensation can be one of the factors which affect left ventricular transient ischemic dilation. (author)

Prognostic significance of myocardial imaging with iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid in patients with angina pectoris

International Nuclear Information System (INIS)

Hatano, Tsuguhisa; Chikamori, Taishiro; Kamada, Tatsuya; Morishima, Takayuki; Hida, Satoshi; Yanagisawa, Hidefumi; Iino, Hitoshi; Yamashina, Akira

2001-01-01

To assess the clinical significance of iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT), the predictive value of BMIPP imaging in patients with angina pectoris was evaluated. One hundred seventy-four patients who underwent BMIPP imaging in our institution were aged 61.8±11 years. One hundred thirty-five patients had stable angina and 39 had unstable angina at the time of examination. Patients with previous myocardial infarction or myocardial disorders were excluded. Early and delayed images were acquired in BMIPP SPECT, and the images were analyzed visually. Cardiac events were classified into hard and soft events: the former consisted of cardiac death and nonfatal myocardial infarction, and the latter included coronary revascularization and heart failure. The findings of BMIPP imaging were normal in 82 patients and abnormal in 92. During follow-up of 15.5±9.5 months, hard events were observed in 4 patients and soft events in 53. In patients with normal BMIPP imaging, soft events were observed in nine patients, but no hard event was encountered. Furthermore, in patients with both normal BMIPP and stress thallium imagings, no cardiac event was observed during 2 years. In contrast, 4 hard events and 44 soft events occurred in patients with abnormal BMIPP imaging. Patients with abnormal BMIPP imaging had a higher incidence of soft events than those with normal BMIPP imaging, regardless of the type of angina (16/62 vs 3/73, p<0.0005 for stable angina; 28/30 vs 6/9, p<0.0001 for unstable angina). The finding of BMIPP imaging correlates well with the mid-term prognosis of patients with angina pectoris. Since BMIPP SPECT is performed without stress to the patient, this imaging modality is important in evaluating patients with stable or unstable angina. (author)

The cardiomyopathy in Friedreich's ataxia: isotopic ventriculography and myocardial imaging with thallium-201

International Nuclear Information System (INIS)

Therriault, L.; Lamoureux, G.; Cote, M.; Plourde, G.; Lemieux, B.

1984-01-01

Myocardial scanning after the intravenous administration of Thallium 201 was used to evaluate regional myocardial perfusion in 14 patients with Friedreich's ataxia. Isotopic ventriculography was also used to assess left ventricular contractility. Myocardial images in patients with Friedreich's ataxia were found to be precociously abnormal irrespective of the degree of neurological impairment or of the severity of myocardial hypertrophy

Stress cardiomyopathy syndrome: a contemporary review.

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Kapoor, Divya; Bybee, Kevin A

2009-12-01

Stress cardiomyopathy (SC) syndrome represents a reversible form of cardiomyopathy that commonly presents proximate to an acute emotional or physiologic stressor. The clinical presentation is similar to an acute coronary syndrome in the absence of obstructive coronary artery disease to explain the unusual distribution of associated transient wall motion abnormalities. Postmenopausal women seem particularly prone to SC for unclear reasons. The pathophysiology of the syndrome is unknown but may involve pathologic sympathetic myocardial stimulation.

Normal myocardial perfusion scan portends a benign prognosis independent from the pretest probability of coronary artery disease. Sub-analysis of the J-ACCESS study

International Nuclear Information System (INIS)

Imamura, Yosihiro; Fukuyama, Takaya; Nishimura, Sigeyuki; Nishimura, Tsunehiko

2009-01-01

We assessed the usefulness of gated stress/rest 99mTc-tetrofosmin myocardial perfusion single photon emission computed tomography (SPECT) to predict ischemic cardiac events in Japanese patients with various estimated pretest probabilities of coronary artery disease (CAD). Of the 4031 consecutively registered patients for a J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) study, 1904 patients without prior cardiac events were selected. Gated stress/rest myocardial perfusion SPECT was performed and segmental perfusion scores and quantitative gated SPECT results were derived. The pretest probability for having CAD was estimated using the American College of Cardiology/American Heart Association/American College of Physicians- American Society of Internal Medicine guideline data for the management of patients with chronic stable angina, which includes age, gender, and type of chest discomfort. The patients were followed up for three years. During the three-year follow-up period, 96 developed ischemic cardiac events: 17 cardiac deaths, 8 nonfatal myocardial infarction, and 71 clinically driven revascularization. The summed stress score (SSS) was the most powerful independent predictor of all ischemic cardiac events (hazard ratio 1.077, confidence interval (CI) 1.045-1.110). Abnormal SSS (>3) was associated with a significantly higher cardiac event rate in patients with an intermediate to high pretest probability of CAD. Normal SSS (≤3) was associated with a low event rate in patients with any pretest probability of CAD. Myocardial perfusion SPECT is useful for further risk-stratification of patients with suspected CAD. The abnormal scan result (SSS>3) is discriminative for subsequent cardiac events only in the groups with an intermediate to high pretest probability of CAD. The salient result is that normal scan results portend a benign prognosis independent from the pretest probability of CAD. (author)

Quantitative assessment of myocardial blood flow by measurement of fractional myocardial uptake of 201Tl

International Nuclear Information System (INIS)

Yonekura, Yoshiharu; Ishii, Yasushi; Torizuka, Kanji; Kadota, Kazunori; Kambara, Hirofumi

1980-01-01

Fractional Myocardial uptake of 201 Tl was measured for the quantitative assessment of myocardial blood flow in coronary artery disease (CAD). 10 normals and 28 CAD, 7 of which have less than 50% stenosis (CAD I) and 21 of which have more than 50% stenosis (CAD II) in the proximal portion of coronary arteries, were studied at rest and with submaximal exercise loading by bicycle ergometer. After intravenous injection of 201 Tl, its rapid transport process was recorded during the initial 5 minutes by a scintillation camera and a minicomputer. Total injected dosage (T) was obtained from the counts of the entire chest region during the initial passage of the tracer through the heart and lung. Myocardial uptake (M) was counted with the same geometry from the subsequent accumulation within the myocardial region with subtraction of the background activities in the upper mediastinal region (B). The fractional myocardial uptake of 201 Tl ((M-B)/T) is assumed to be proportional to the fractional myocardial blood flow to cardiac output (MBF/CO) according to the indicator fractionation principle. The average value of MBF/CO at rest in CAD (4.11 +- 1.12%) was significantly greater than in normals (3.36 +- 0.49%), which may be caused by an increased left ventricular mass in CAD. Change rate of MBF/CO on the exercise loading was significantly less in CAD I (1.36 +- 0.14) and in CAD II (1.11 +- 0.21) than in normals (1.75 +- 0.11). MBF/CO increased proportionally to the increment of the double product of heart rate and systolic blood pressure by exercise loading in normals, whereas it didn't in CAD. The sensitivity of this method was superior to the stress electrocardiogram and the stress myocardial perfusion imaging, not only in CAD II but also in CAD I. This result indicated that this type of global assessment of the myocardial reserve capacity is valuable in addition to the simple stress myocardial perfusion imaging. (author)

Myocardial perfusion imaging with dual energy CT

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Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); De Cecco, Carlo N. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome (Italy); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Spandorfer, Adam; Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States)

2016-10-15

Highlights: • Stress dual-energy sCTMPI offers the possibility to directly detect the presence of myocardial perfusion defects. • Stress dual-energy sCTMPI allows differentiating between reversible and fixed myocardial perfusion defects. • The combination of coronary CT angiography and dual-energy sCTMPI can improve the ability of CT to detect hemodynamically relevant coronary artery disease. - Abstract: Dual-energy CT (DECT) enables simultaneous use of two different tube voltages, thus different x-ray absorption characteristics are acquired in the same anatomic location with two different X-ray spectra. The various DECT techniques allow material decomposition and mapping of the iodine distribution within the myocardium. Static dual-energy myocardial perfusion imaging (sCTMPI) using pharmacological stress agents demonstrate myocardial ischemia by single snapshot images of myocardial iodine distribution. sCTMPI gives incremental values to coronary artery stenosis detected on coronary CT angiography (CCTA) by showing consequent reversible or fixed myocardial perfusion defects. The comprehensive acquisition of CCTA and sCTMPI offers extensive morphological and functional evaluation of coronary artery disease. Recent studies have revealed that dual-energy sCTMPI shows promising diagnostic accuracy for the detection of hemodynamically significant coronary artery disease compared to single-photon emission computed tomography, invasive coronary angiography, and cardiac MRI. The aim of this review is to present currently available DECT techniques for static myocardial perfusion imaging and recent clinical applications and ongoing investigations.

Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

International Nuclear Information System (INIS)

Kuijpers, Dirkjan; Dijkman, Paul R.M. van; Janssen, Caroline H.C.; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs

2004-01-01

The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) (P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event (P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy. (orig.)

Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

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Kuijpers, Dirkjan [State University and Academic Hospital Groningen, Department of Radiology and Cardiology, Groningen (Netherlands); Bronovo Hospital, Department of Radiology and Cardiology, Bronovolaan 1, P.O. Box 96900, The Hague (Netherlands); Dijkman, Paul R.M. van [Bronovo Hospital, Department of Radiology and Cardiology, Bronovolaan 1, P.O. Box 96900, The Hague (Netherlands); Janssen, Caroline H.C.; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs [State University and Academic Hospital Groningen, Department of Radiology and Cardiology, Groningen (Netherlands)

2004-11-01

The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) (P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event (P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy. (orig.)

Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia.

Science.gov (United States)

Kuijpers, Dirkjan; van Dijkman, Paul R M; Janssen, Caroline H C; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs

2004-11-01

The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) ( P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event ( P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy.

Detection of unstable angina by /sup 99m/technetium pyrophosphate myocardial scintigraphy

International Nuclear Information System (INIS)

Abdulla, A.M.; Canedo, M.I.; Cortez, B.C.; McGinnis, K.D.; Wilhelm, S.K.

1976-01-01

/sup 99m/Technetium stannous pyrophosphate has been shown to accumulate in acutely infarcted myocardium. To determine if the isotope is also taken up by severely ischemic, but not necrotic myocardium, we performed myocardial scintigraphic studies in 17 patients with chest pains. Seven of the patients satisfied conventional clinical, electrocardiographic, and laboratory criteria for the diagnosis of unstable angina and showed no electrocardiographic or enzymatic evidence of myocardial necrosis. Five of these seven patients with unstable angina demonstrated abnormal localized patterns, and one showed a borderline picture. Myocardial scintiscans were normal in all of a control group of ten patients with stable angina. Thus, scanning with /sup 99m/technetium stannous pyrophosphate is shown to be of value in the objective demonstration of myocardial abnormality in unstable angina

Dynamic HDA-123-I-myocardial scintigraphy after aortocoronary bypass grafting

International Nuclear Information System (INIS)

Fridrich, L.; Gassner, A.; Sommer, G.; Kneussl, M.; Pichler, M.; Klicpera, M.; Salomonowitz, E.

1986-01-01

In an attempt to evaluate the dynamics of fatty acid metabolism after aortocoronary bypass grafting (ACBG), ten patients were investigated after ACBG by HDA-I-123 myocardial scintigraphy. Tracer kinetics were followed for 90 min and compared to those of 36 non-grafted patients with different underlying heart diseases, including healthy volunteers. Regional analysis and mono-exponential curve fitting were used to evaluate tsub(1/2) (half-life of the early period of tracer elimination); biexponential curve analysis was used to calculate Ca/Cb, the ratio of a fast and a slow component of tracer elimination. Rest and stress MUGA-RNV served as discriminating parameters to discern between patient groups with normal and abnormal ventricular function. Group I (normal controls) encompassed ten patients with normal ventricular function, including three after ACBG, and group II seven patients after ACBG and with abnormal ventricular function. Group III had coronary artery disease (CAD) documented by angiography, and group IV by prior myocardial infarction. Group V included patients with cardiomyopathy. Regional analysis of group II revealed no significant differences to control regions (Gr I) for tsub(1/2) or Ca/Cb, but showed for Ca/Cb a nonsignificant shift toward group III values. However, group II differed significantly from group III and V. three patients with normal ventricular function after ACBG showed elimination values that were all well within the range of completely normal individuals. Thus our data support the assumption that a normal function is indicative of a normal metabolism. Following myocardial fatty acid metabolism during rest might be a helpful noninvasive tool for etiologic differentiation of disturbed ventricular function. (orig.)

Is attenuation correction of myocardial SPET scans worth the effort?

International Nuclear Information System (INIS)

Nguyen, D.; Saunders, C.; Dixson, H.; Cook, P.; Burnett, P.; Croll, F.; Dunn, R.; Hasche, E.; Kelleher, P.; Nasser, F.; Wilson, D.; Lee, K.

1999-01-01

Full text: In this prospective study, we compared gated (GS), attenuation-corrected (AC) and non-attenuation-corrected (NAC) myocardial SPET scans. 119 consecutive patients were scanned after 800 MBq 99 Tc m -Sestamibi (MIBI) injected at peak stress. AC studies were performed using a Siemens Multispect 3 triple-headed camera with a MμSIC attenuation correction system. Transmission data were provided by an Am241 line source mounted opposite an offset fan beam collimator. Simultaneous emission data were collected from all 3 heads over a 360deg rotation (acquisition time 25 min). The NAC and GS studies were performed using a Siemens ECAM variable-angle dual-headed gamma camera using 8 gating frames over a 90deg rotation (acquisition time 15 min). The myocardium was divided into 9 segments and the studies were reported separately by two observers. Clinical data and angiography results were obtained when available. For GS, myocardial segments with normal systolic wall thickening were considered to have normal perfusion. AC studies were used as the standard for measuring myocardial perfusion. In the 119 patients studied, the overall sensitivity, specificity and accuracy for NAC vs AC were 100%, 25%, 54% and for GS vs AC were 86%, 84% and 85% respectively. There were 265 abnormal segments on NAC. GS demonstrated normal thickening in 90/265 segments and AC demonstrated normal perfusion in 94/265 segments. There were 33 segments with discordant GS and AC. 16/33 segments (9 inferior, 3 anterior, 4 other) with normal thickening had abnormal perfusion on AC and 17/33 segments (9 inferior, 6 anterior, 2 other) with abnormal thickening had normal perfusion on AC. Weight and sex did not predict discordance. In conclusion, attenuation artefacts are common and are not predicted by body habitus or sex. They are usually accurately identified by normal systolic wall thickening on GS. GS is strongly recommended when AC is not available. AC provides additional information, particularly

Abnormal tibiofemoral contact stress and its association with altered kinematics following center-center ACL reconstruction: an in vitro study

Science.gov (United States)

Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas

2014-01-01

Background Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the ACL-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics following ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress following ACL reconstruction? Hypothesis/Purpose Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics following ACL reconstruction will exist. Study Design Controlled laboratory study Methods Clinical tests of anterior and rotational stability were simulated on eleven cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau and mean contact stress was calculated regionally. Results ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however contact stress abnormalities remained. On average, kinematics were overconstrained following ACL reconstruction (≤1.8mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in ab/adduction and medial-lateral translation in response to combined moments, and axial rotation, anterior-posterior and medial-lateral translation in response to an anterior load were

Segmental wall motion abnormalities in dilated cardiomyopathy: hemodynamic characteristics and comparison with thallium-201 myocardial scintigraphy

International Nuclear Information System (INIS)

Yamaguchi, S.; Tsuiki, K.; Hayasaka, M.; Yasui, S.

1987-01-01

This study assessed the hemodynamic characteristics of segmental wall motion abnormality of the left ventricle in patients with dilated cardiomyopathy (DCM) and its relation to the thallium-201 (TI-201) myocardial scintigraphy (MPI). Left ventriculograms and MPI in 23 patients were analyzed by the use of quantitative indexes of regional wall motion and TI-201 uptake based on a mean and a standard deviation of 13 normal subjects. Relative normokinesis in our definition was more frequently seen in the inferior wall than in the anterior wall (p less than 0.01). In contrast, severe asynergy was more often seen in the anterior wall than in the inferior wall (p less than 0.01). There were 11 patients who had relative normokinesis and asynergy together. By means of the index of wall motion, the DCM patients were divided into two groups, one with segmental wall motion abnormality (SWMA) and another with diffuse wall motion abnormality (DWMA). The DWMA group had higher left ventricular end-diastolic pressures (p less than 0.05) and the tendency of large left ventricular end-diastolic volumes than the SWMA group. There was a rough correlation (r = 0.58) between the quantitative indexes of TI-201 uptake and wall motion at the same region of the left ventricle. Thus, the nonuniformity of the left ventricular wall motion was recognized in the patients with DCM and more increased preload was shown in the patients with DWMA than in the group with SWMA. Further, the regional asynergy may be related to the localized fibrosis within the left ventricle in DCM, considering the result that the worse TI-201 uptake was roughly accompanied by the more severe asynergy

Effect of fructose diphosphate combined with large-dose vitamin C therapy on the myocardial oxidative stress injury after neonatal asphyxia

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Chun-Hua Liang1

2017-04-01

Full Text Available Objective: To study the effect of fructose diphosphate combined with large-dose vitamin C therapy on the myocardial oxidative stress injury after neonatal asphyxia. Methods: 40 patients with neonatal asphyxia who were treated in our hospital between June 2013 and April 2016 were collected and divided into the control group (n=20 who received large-dose vitamin C therapy and the observation group (n=20 who received fructose diphosphate combined with large-dose vitamin C therapy according to the double-blind randomized control method, and the treatment lasted for 10 d. Immediately after admission and after 10 d of treatment, RIA method was used to detect the serum levels of oxidative stress indexes, color Doppler diasonograph was used to determine left cardiac function parameters, and the myocardial enzyme spectrum detector was used to determine myocardial enzyme spectrum index levels. Results: Immediately after admission, the differences in the systemic oxidative stress degree, the left cardiac function damage degree and the myocardial enzyme spectrum index levels were not statistically significant between two groups of patients (P>0.05. After 10 d of treatment, serum malondialdehyde (MDA, advanced oxidation protein products (AOPP, creatine kinase isoenzyme (CK-MB, N-terminal pro-brain natriuretic peptide (Nt-proBNP, heart-type fatty acid-binding protein (H-FABP and troponin I (cTnI contents of observation group were lower than those of control group (P<0.05 while superoxide dismutase (SOD content was higher than that of control group (P<0.05, and the left cardiac function parameter ejection time (ET level was higher than that of control group (P<0.05 while left ventricular isovolumetric contraction time (ICT and left ventricular isovolumetric relaxation time (IRT levels were lower than those of control group (P<0.05. Conclusion: Fructose diphosphate combined with large-dose vitamin C can reduce the systemic oxidative stress of neonatal asphyxia

Functional assessment of sequential coronary artery fistula and coronary artery stenosis with fractional flow reserve and stress adenosine myocardial perfusion imaging

Directory of Open Access Journals (Sweden)

Kuan Leong Yew

2015-10-01

Full Text Available Coronary artery fistula is an abnormal connection between one coronary artery to another coronary artery or cardiac chambers. The coronary artery fistula may cause significant shunting of blood and cause “pseudo-stenosis” or “steal phenomenon”. This will also accentuate pre-existing mild-moderate de novo coronary lesions with resultant greater pressure gradient difference across the lesions. Thus, fractional flow reserve can be a useful tool to guide intervention decision on the coronary artery fistula. There are very few published reports regarding the use of FFR to assess coronary artery fistula. In fact, there is no outcome data regarding the deferment of coronary artery fistula intervention when the FFR is not physiologically significant. This case highlighted the use of FFR to evaluate the functional significance of coronary fistula in the setting of ischemia evaluation and it was proven to be safe to defer intervention with good 3 year clinical outcome. Stress adenosine myocardial perfusion imaging correlated with the FFR result.

Usefulness of dipyridamole stress myocardial imaging in patients who have exercise limitations due to various orthopedic disorders

International Nuclear Information System (INIS)

Tagawa, Hirofumi; Ashihara, Toshiaki; Fukuyama, Takaya; Matsui, Kanji; Yamamoto, Sumiki; Yamamoto, Susumu

1994-01-01

To evaluate the presence of coronary artery disease in patients unable to exercise adequately because of chronic rheumatoid arthritis, osteoarthritis, hip bone fractures or disk herniation, we performed dipyridamole-stress thallium-201 myocardial imaging in thirty-three patients. Twelve of the 33 patients showed perfusion defect and redistribution by thallium imaging. Coronary angiography was performed in 9 patients out of these 12 dipyridamole-positive patients and significant coronary artery stenosis was detected in 7 of them (78%). Due to these results of dipyridamole-imaging and coronary angiograms, surgical intervention for the underlying bone or joint disorder was performed under cardioprotective strategy in 15 patients, in which no cardiovascular events occurred. Thus, dipyridamole-stress myocardial imaging is a satisfactory alternative to the exercise test for detecting coronary artery disease in patients with bone or joint disorders. (author)

Normal stress-only myocardial single photon emission computed tomography predicts good outcome in patients with coronary artery stenoses between 40 and 70.

Science.gov (United States)

Jiang, Zhixin; Liu, Yangqing; Xin, Chaofan; Zhou, Yanli; Wang, Cheng; Zhao, Zhongqiang; Li, Chunxiang; Li, Dianfu

2016-09-01

Normal stress myocardial single photon emission computed tomography (SPECT) usually indicates good physiologic function of all coronary lesions, and also indicates a good outcome. We hypothesize that it can still predict good outcome in patients with coronary stenoses between 40 and 70%. A group of patients who underwent stress myocardial SPECT after coronary angiography were consecutively recruited in our center. Patients were eligible if they had one or more coronary stenoses between 40 and 70%. Patients with coronary stenoses greater than 50% diameter of left main or greater than 70% diameter of nonleft main epicardial vessels, and left ventricular ejection fraction less than 50% were excluded. The outcome was defined as major adverse events, including cardiac death, nonfatal myocardial infarction, and revascularization. Patients' survival curves were constructed accorded to the method of Kaplan and Meier and compared using the log-rank test. A study cohort of 77 patients was enrolled. According to the summed stress score, 43 patients were assigned to the perfusion defect group and 34 patients were assigned to the perfusion normal group. The follow-up duration was 6.4±0.3 years. In the perfusion normal group, only one of 34 (2.9%) patients developed major adverse events. In the perfusion defect group, six of 43 (14%) developed major adverse events, P-value of 0.041. It is safe to defer a percutaneous coronary intervention in patients with coronary stenoses between 40 and 70% and normal stress myocardial SPECT.

Myocardial delayed-enhancement CT: initial experience in children and young adults

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Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of)

2017-10-15

Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality. (orig.)

Myocardial delayed-enhancement CT: initial experience in children and young adults

International Nuclear Information System (INIS)

Goo, Hyun Woo

2017-01-01

Clinical utility of myocardial delayed enhancement CT has not been reported in children and young adults. To describe initial experience of myocardial delayed enhancement CT regarding image quality, radiation dose and identification of myocardial lesions in children and young adults. Between August 2013 and November 2016, 29 consecutive children and young adults (median age 16 months) with suspected coronary artery or myocardial abnormality underwent arterial- and delayed-phase cardiac CT at our institution. We measured CT densities in normal myocardium, left ventricular cavity, and arterial and delayed hypo-enhancing and delayed hyperenhancing myocardial lesions. We then compared the extent of delayed hyperenhancing lesions with delayed-enhancement MRI or thallium single-photon emission CT. Normal myocardium and left ventricular cavity showed significantly higher CT numbers on arterial-phase CT than on delayed-phase CT (t-test, P<0.0001). Contrast-to-noise ratios of the arterial and delayed hypo-enhancing and delayed hyperenhancing lesions on CT were 26.7, 17.6 and 18.7, respectively. Delayed-phase CT findings were equivalent to those of delayed-enhancement MRI in all cases (7/7) and to those of thallium single-photon emission CT in 70% (7/10). Myocardial delayed-enhancement CT can be added to evaluate myocardial lesions in select children and young adults with suspected coronary artery or myocardial abnormality. (orig.)

Xanthine Oxidase Inhibitor, Allopurinol, Prevented Oxidative Stress, Fibrosis, and Myocardial Damage in Isoproterenol Induced Aged Rats.

Science.gov (United States)

Sagor, Md Abu Taher; Tabassum, Nabila; Potol, Md Abdullah; Alam, Md Ashraful

2015-01-01

We evaluated the preventive effect of allopurinol on isoproterenol (ISO) induced myocardial infarction in aged rats. Twelve- to fourteen-month-old male Long Evans rats were divided into three groups: control, ISO, and ISO + allopurinol. At the end of the study, all rats were sacrificed for blood and organ sample collection to evaluate biochemical parameters and oxidative stress markers analyses. Histopathological examinations were also conducted to assess inflammatory cell infiltration and fibrosis in heart and kidneys. Our investigation revealed that the levels of oxidative stress markers were significantly increased while the level of cellular antioxidants, catalase activity, and glutathione concentration in ISO induced rats decreased. Treatment with allopurinol to ISO induced rats prevented the elevated activities of AST, ALT, and ALP enzymes, and the levels of lipid peroxidation products and increased reduced glutathione concentration. ISO induced rats also showed massive inflammatory cells infiltration and fibrosis in heart and kidneys. Furthermore, allopurinol treatment prevented the inflammatory cells infiltration and fibrosis in ISO induced rats. In conclusion, the results of our study suggest that allopurinol treatment is capable of protecting heart of ISO induced myocardial infarction in rats probably by preventing oxidative stress, inflammation, and fibrosis.

The diagnosis of silent myocardial ischemia. Motion-Frozen (or morphing) myocardial perfusion imaging.

Science.gov (United States)

Chang, Cheng; Ye, Bo; Xie, Wenhui; Zhang, Daoliang; Lei, Bei; Ye, Xiaodan

2016-01-01

Silent myocardial ischemia is typically defined as objective evidence of myocardial ischemia in patients without subjective ischemia symptoms. Currently, coronary artery angiography is the gold standard for diagnosis of asymptomatic coronary artery disease (CAD). Computed tomography coronary angiography (CTCA) can visually demonstrate the morphology, trend and extent of coronary stenosis and is commonly used in clinical screening of CAD. Myocardial perfusion imaging can be used not only to identify whether anatomical stenosis causes myocardial dysfunction, but to also assess the risk stratification and prognosis of myocardial disease (MD). Myocardial perfusion imaging using morphing combined with CTCA can simultaneously show the relationship between CAD and myocardial ischemia from an anatomical and functional aspect. This allows earlier diagnosis of asymptomatic CAD myocardial ischemia, accurate identification of the culprit vessels, and could prevent unnecessary interventional therapy. The 1-day dobutamine stress/resting met-hod is also one of the methods used. The combination of CTCA and the morphing technique can provide anatomical and functional information on coronary arteries at the same time, significantly improving the diagnostic sensitivity, specificity, and accuracy of MD.

The impact of exercise myocardial perfusion SPECT imaging on the selection of patients for coronary angiography

International Nuclear Information System (INIS)

Song Liping; He Zuoxiang; Liu Xiujie; Shi Rongfang; Liu Yunzhong; Tian Yueqin; Zhang Xiaoli; Qin Xuewen; Chen Jilin; Gao Runlin

2001-01-01

Objective: Exercise 99 Tc m -MIBI myocardial perfusion SPECT is accurate for the diagnosis of coronary artery disease (CAD). This study assessed the impact of exercise myocardial perfusion imaging on the selection of patients for coronary angiography. Methods: 2188 consecutive patients who underwent exercise myocardial perfusion SPECT in authors' department in 1999 were retrospectively analyzed. Among them, 1807 were men, 381 women (average age: 53.5 +- 7.2 years). Overall, exercise myocardial SPECT was normal in 1731 patients, abnormal in 359 cases, and equivocal in 98 patients. There were 141 patients who underwent CAG within 60 days after myocardial SPECT. Results: Overall, 12% of the patients with abnormal SPECT imaging underwent coronary angiography, but only 5% of the patients with a normal SPECT imaging did (P < 0.001). Among these 141 patients who underwent coronary angiography, significant coronary stenosis was present in 91% of the patients who had had an abnormal SPECT imaging, but only 8% of those who had had a normal SPECT imaging (P < 0.001). In those patients who underwent coronary angiography, revascularization rate was 25% for the patients with abnormal SPECT imaging, but only 1% for the patients with a normal SPECT imaging. Conclusion: The results of exercise myocardial perfusion SPECT have a significant impact on the selection of patients for coronary angiography and revascularization

Assessment of myocardial viability using multidetector computed tomography in patients with reperfused acute myocardial infarction

International Nuclear Information System (INIS)

Kim, T.; Choi, B.J.; Kang, D.K.; Sun, J.S.

2012-01-01

Aim: To assess the prognostic value of 64-section multidetector computed tomography (MDCT) to predict follow-up myocardial dysfunction and functional recovery after reperfusion therapy in patients with acute myocardial infarction (MI) as defined by echocardiography. Materials and methods: After reperfusion therapy for acute MI, 71 patients underwent two-phase contrast-enhanced MDCT and follow-up echocardiography. MDCT findings were compared with echocardiographic findings using kappa statistics. The areas under the receiver operating characteristic curves (AUCs) and the odds ratios (ORs) of early perfusion defects (EPD), delayed enhancement (DE), and residual perfusion defects (RPD) for predicting follow-up myocardial dysfunction and functional recovery were calculated on a segmental basis. Results: The presence of transmural EPD (EPD TM ) or RPD showed good agreement (k = 0.611 and 0.658, respectively) with follow-up myocardial dysfunction, while subendocardial EPD (EPD sub ) or subendocardial DE (DE sub ) showed fair agreement with follow-up myocardial dysfunction (k = 0.235 and 0.234, respectively). The AUC of RPD (0.796) was superior (p TM (0.761) and DE TM (0.771). The presence of EPD TM , DE TM , and RPD were significant, independent positive predictors of follow-up myocardial dysfunction (OR = 6.4, 1.9, and 9.8, respectively). EPD TM was a significant, independent negative predictor of myocardial functional recovery (OR = 0.13). Conclusion: Abnormal myocardial attenuation on two-phase MDCT after reperfusion therapy may provide promising information regarding myocardial viability in patients with acute MI.

Is dipyridamole test equivalent to exercise testing for the performing of myocardial tomo-scintigraphy? preliminary results of a systematic comparative analysis in patients having documented episodes of myocardial ischemia

International Nuclear Information System (INIS)

David, N.; Quiri, N.; Hassan, N.; Arsena, T.; Py, M.; Olivier, P.; Karcher, G.; Bertrand, A.; Houriez, P.; Grentzinger, A.; Angioi, M.; Danchin, N.; Juilliere, Y.

1997-01-01

Dipyridamole test is generally used rather than exercise testing when myocardial tomo-scintigraphy (MTS) is performed with patients unable to perform a maximal exercise test. However, this choice has never been validated by a systematic comparative analysis of the results provided by these two stress techniques with patients having a documented myocardial ischemia. We have included 20 patients who had a known coronary artery disease, for whom exercise test was positive at the time of an exercise MTS-TI201 performed in our department and who underwent an additional MTS-TI201 after intravenous administration of 0,56 mg/kg of dipyridamole and low-level exercise testing (40 W). The extent of perfusion abnormalities, observed after dipyvirdamole, was not significantly different from that evidenced at exercise, even in the analysis restricted to the eight patients who had a sub-maximal test (<80 % of predicted maximal heart rate) at the time of exercise-MTS (% of left ventricle: 17 ± 13 vs 15 ± 8). By contrast, there were important individual variations: a difference in defect-extent (≥ 10 % of left ventricle) was observed between the two tests for 11 patients (55 %), the largest defect being that observed at exercise in six cases, and after dipyridamole in five cases. With patients having exercise myocardial ischemia, the MTS obtained after dipyridamole are frequently very different from those performed after exercise, and the criterion of a low maximal heart rate doses not imply an underestimation of the perfusion abnormalities observed at exercise. (authors)

Familial Risk for Insomnia Is Associated With Abnormal Cortisol Response to Stress.

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Drake, Christopher L; Cheng, Philip; Almeida, David M; Roth, Thomas

2017-10-01

Abnormalities in the stress system have been implicated in insomnia. However, studies examining physiological stress regulation in insomnia have not consistently detected differences in the hypothalamic-pituitary-adrenal (HPA)-axis response to stress. One explanation may be that deficits in the stress system are associated specifically with a biological vulnerability to insomnia rather than the phenotypic expression of insomnia. To examine stress response as a function of vulnerability to insomnia, this study tested response to the Trier Social Stress Test in a sample of healthy sleepers with varying familial risks for insomnia. Thirty-five healthy individuals with and without familial risk for insomnia were recruited to complete a laboratory stressor. Participants with one or both biological parents with insomnia were categorized as positive for familial risk, whereas those without biological parents with insomnia were categorized as negative for familial risk. Participants completed the Trier Social Stress Test in the laboratory, and psychological and physiological (autonomic and HPA-axis) responses were compared. Despite self-reported increases in anxiety, those positive for familial risk exhibited a blunted cortisol response relative to those without familial risk for insomnia. Individuals with blunted cortisol also reported heightened reactivity to personal life stressors, including increased sleep disturbances, elevated cognitive intrusions, and more behavioral avoidance. Findings from this study provide initial evidence that abnormal stress regulation may be a biological predisposing factor conferred via familial risk for insomnia. This deficit may also predict negative consequences over time, including insomnia and the associated psychiatric comorbidities. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

The myocardial perfusion imaging of bone marrow mesenchymal stem cell transplantation treated acute myocardial infarction in pig

International Nuclear Information System (INIS)

He Miao; Hou Xiancun; Li Yaomei; Zhou Peng; Qi Chunmei; Wu Weihuan; Li Li

2006-01-01

Objective: To evaluate the clinical value of bone marrow mesenchymal stem cell transplantation on acute myocardial infarction in pig with myocardial perfusion imaging. Methods: Acute myocardial infarction models were established by 21 minitype Chinese pigs and were divided into two groups. After 10 days, experimental group (n=11) was transplanted with bone marrow mesenchymal stem cell at the infarct areas, and the control group (n=10) with incubation solution. Before and eight weeks after transplantation, both groups were examined by 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and with semi-quantitative analysis. Besides, echocardiogram and immunohistochemistry were also performed. Results: There was significant difference of total myocardial perfusion abnormal segments (46 vs 26), infarct areas [(34±12)% vs (21±10)%] and myocardial ischemia score [(20.0±4.3) vs (12.1±3.6)] between two groups (P<0.05). Also, there were accordant results with echocardiogram and immunohistochemistry findings. Conclusions: Bone marrow mesenchymal stem cell transplantation may improve blood perfusion and viability of the ischemic areas: Myocardial perfusion imaging can accurately observe the survival of bone marrow mesenchymal stem cell transplanted at the infarct areas. (authors)

Feasibility and diagnostic power of transthoracic coronary Doppler for coronary flow velocity reserve in patients referred for myocardial perfusion imaging

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Nylander Eva

2008-03-01

Full Text Available Abstract Background Myocardial perfusion imaging (MPI, using single photon emission computed tomography (SPECT is a validated method for detecting coronary artery disease. Transthoracic Doppler echocardiography (TTDE of flow at rest and during adenosine provocation has previously been evaluated in selected patient groups. We therefore wanted to compare the diagnostic ability of TTDE in the left anterior descending coronary artery (LAD to that of MPI in an unselected population of patients with chest pain referred for MPI. Our hypothesis was that TTDE with high accuracy would identify healthy individuals and exclude them from the need for further studies, enabling invasive investigations to be reserved for patients with a high probability of disease. Methods Sixty-nine patients, 44 men and 25 women, age 61 ± 10 years (range 35–82, with a clinical suspicion of stress induced myocardial ischemia, were investigated. TTDE was performed at rest and during adenosine stress for myocardial scintigraphy. Results We found that coronary flow velocity reserve (CFVR determined from diastolic measurements separated normal from abnormal MPI findings with statistical significance. TTDE identified coronary artery disease, defined from MPI, as reversible ischemia and/or permanent defect, with a sensitivity of 60% and a specificity of 79%. The positive predictive value was 43% and the negative predictive value was 88%. There was an overlap between groups which could be due to abnormal endothelial function in patients with normal myocardial perfusion having either hypertension or diabetes. Conclusion TTDE is an attractive non-invasive method to evaluate chest pain without the use of isotopes, but the diagnostic power is strongly dependent on the population investigated. Even in our heterogeneous clinical cardiac population, we found that CFVR>2 in the LAD excluded significant coronary artery disease detected by MPI.

A Survey of Coping Strategies With Stress in Patients With Acute Myocardial Infarction and Individuals Without a History of Fixed Myocardial Infarction.

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Sadr Bafghi, Seyed Mahmood; Ahmadi, Nastaran; Yassini Ardekani, Seyyed Mojtaba; Jafari, Lida; Bitaraf Ardekani, Bahareh; Heydari, Roya; Maroufi, Fahame; Faraji, Reza

2018-02-01

This study aimed at investigating the coping strategies with stress in patients with acute myocardial infarction (MI) and individuals without a history of fixed MI and cardiovascular disorders. This case-control crossover study was conducted from March 2015 to February 2016 on 220 patients with acute MI (MI patients) as case group and 220 patients without any history of MI and cardiovascular diseases as the control group using availability sampling method. To collect the required data, demographic information questionnaire, Holms-Raheh life stress inventory, perceived stress questionnaire, and coping inventory for stressful situations (CISS) were applied. On the basis of our findings, 118 patients (53.6%) with MI used emotion-focused coping strategy. Ninety-seven patients (82.2%) with MI who used emotion-focused coping strategy had negative perceived stress. Additionally, 71 patients (60.2%) with MI who had used emotion-focused coping strategy suffered from very high level of stress. The most MI patients had very high level of stress while most people in control group had high level of stress. Most MI patients that had very high level of stress cope with it in emotion-focused coping strategy and it proves that people with higher levels of stress are more likely to use inefficient coping strategies.

Clinical correlations, lactate extraction, coronary venous bloodflow and Thallium-201 myocardial imaging in patients with isolated left anterior descending muscle brigdes: Normal variant or obstruction

International Nuclear Information System (INIS)

Voss, H.; Kupper, W.; Hanrath, P.; Mathey, D.; Montz, R.; Buecking, J.; Hamburg Univ.; Hamburg Univ.

1980-01-01

In 848 coronary arteriograms performed in a two-years period 21 patients (2.5%) showed a myocardial bridging of the left anterior descending artery. Resting- and/or stress-ECG were abnormal in half of the patients. Regional lactate-metabolism measured in the great cardiac vein at rest and during maximal atrial pacing was normal (29 +- 12 resp. 24 +- 9%). Thermodilution of great cardiac vein bloodflow at rest and during atrial pacing also demonstrated normal values (94 +- 33 resp. 138 +- 30 ml/min). Biphasic 201-Thallium myocardial imaging revealed no case of reversible perfusion defect, but surprisingly frequent (5 of 16 patients) clearly irreversible defects limited to the interventricular septum. We conclude that muscle bridges do not cause myocardial ischemia at rest or during exercice. (orig.) [de

Edaravone protects rats against oxidative stress and apoptosis in experimentally induced myocardial infarction: Biochemical and ultrastructural evidence.

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Hassan, Md Quamrul; Akhtar, Md Sayeed; Akhtar, M; Ali, Javed; Haque, Syed Ehtaishamul; Najmi, Abul Kalam

2015-01-01

The present study was designed to evaluate the cardioprotective potential of edaravone on oxidative stress, anti-apoptotic, anti-inflammatory and ultrastructure findings in isoproterenol (ISO) induced myocardial infarction (MI) in rats. Rats were pretreated with edaravone (1, 3, 10 mg/kg body weight-1 day-1) intraperitoneally. MI was induced by subcutaneous administration of ISO (85 mg/kg body weight-1) at two doses with 24h interval. ISO treated rats showed significant increase in the levels of thiobarbituric acid reactive substances (TBARS) and decreased levels of reduced glutathione, glutathione perdoxidase, glutathione reductase and glutathione-S- transferase in the cardiac tissues. Moreover, significant increase in the levels of lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), C--reactive protein and caspase-3 activity was observed in ISO treated group. Pretreatment of ISO intoxicated rats with edaravone showed significant decrease in the level of TBARS, increased activities of antioxidant enzymes and significantly decreased levels of LDH and CK-MB. Moreover, results also showed decreased C-reactive protein level, caspase-3 activity and maintained ultrastructure of the myocardial cells. Our study suggests that edaravone possess strong cardioprotective potential. Edaravone may have exhibited cardioprotective effects by restoring antioxidant defense mechanism, maintaining integrity of myocardial cell membrane, reducing apoptosis and inflammation against ISO induced MI and associated oxidative stress.

Electrocardiographic markers of ischemia during mental stress testing in postinfarction patients. Role of body surface mapping

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Bosimini, E.; Galli, M.; Guagliumi, G.; Giubbini, R.; Tavazzi, L.

1991-01-01

In patients with coronary artery disease, radionuclide investigations have documented a high incidence of mental stress-induced myocardial ischemia in the absence of significant electrocardiographic changes and/or angina. To investigate the causes of the low electrocardiographic sensitivity, we recorded body surface maps during mental arithmetic in 22 normal volunteers and 37 postinfarction patients with residual exercise ischemia. Myocardial perfusion was studied with thallium-201 or technetium-99 (SESTAMIBI) planar scans. In 14 patients, body surface maps were also recorded during atrial pacing at the heart rate values achieved during mental stress. While taking the body surface maps, the area from J point to 80 msec after this point (ST-80) was analyzed by integral maps, difference maps, and departure maps. The body surface mapping criteria for ischemia were a new negative area on the integral maps, a negative potential of more than 2 SD from mean normal values on the difference maps, and a negative departure index of more than 2. Scintigraphy showed asymptomatic myocardial hypoperfusion in 33 patients. Eight patients had significant ST segment depression. The ST-80 integral and difference maps identified 17 ischemic patients. Twenty-four patients presented abnormal departure maps. One patient presented ST depression and abnormal body surface maps without reversible tracer defect. In 14 of 14 patients, atrial pacing did not reproduce the body surface map abnormalities. The analyses of the other electrocardiographic variables showed that in patients with mental stress-induced perfusion defects, only changes of T apex-T offset (aT-eT) interval in Frank leads and changes of maximum negative potential value of aT-eT integral maps significantly differed from those of normal subjects

Reduction of myocardial blood flow reserve in idiopathic dilated cardiomyopathy without overt heart failure and its relation with functional indices: an echo-Doppler and positron emission tomography study.

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Morales, Maria-Aurora; Neglia, Danilo; L'Abbate, Antonio

2008-08-01

Myocardial blood flow during pharmacological vasodilatation is depressed in patients with idiopathic dilated cardiomyopathy even the in absence of overt heart failure; the extent of myocardial blood flow abnormalities is not predictable by left ventricular ejection fraction (LVEF) and diastolic dimensions. To assess whether myocardial blood flow impairment in idiopathic dilated cardiomyopathy without overt heart failure can be related to Doppler-derived dP/dt and to echocardiographically determined left ventricular end systolic stress - which is linked to myocardial blood flow reserve in advanced disease. Twenty-six patients, New York Heart Association Class I-II, (LVEF 37.4 +/- 1.4%, left ventricular diastolic dimensions 62.6 +/- 0.9 mm) underwent resting/dipyridamole [13N]NH3 flow positron emission tomography and an ultrasonic study. Regional myocardial blood flow values (ml/min per g) were computed from positron emission tomography data in 13 left ventricular (LV) myocardial regions and averaged to provide mean myocardial blood flow and myocardial blood flow reserve, defined as dipyridamole/resting mean myocardial blood flow ratio. Resting myocardial blood flow was 0.686 +/- 0.045, dipyridamole myocardial blood flow 1.39 +/- 0.15 and myocardial blood flow reserve 2.12 +/- 0.2, lower than in controls (P < 0.01). The ratio dP/dt was directly related to dipyridamole myocardial blood flow and myocardial blood flow reserve (r = 0.552 and 0.703, P < 0.005 and P < 0.0001); no relation was found between myocardial blood flow and LVEF left ventricular diastolic dimensions, and left ventricular end systolic stress. In idiopathic dilated cardiomyopathy patients without overt heart failure, the extent of myocardial blood flow reserve impairment is related to dP/dt but not to more classical indices of left ventricular function.

A new protocol of dual energy acquisition on stress 201Tl and rest 99mTc-tetrofosmin myocardial scintigraphy

International Nuclear Information System (INIS)

Maeno, Masakazu; Matsuo, Takeshi; Imamura, Takurou; Koiwaya, Yasushi; Eto, Tanenao; Nagamachi, Shigeki; Jinnouchi, Seishi

2001-01-01

We carried out stress 201 Tl (Tl) and rest 99m Tc-tetrofosmin (TF) myocardial scintigraphy with dual energy acquisition in 24 patients with suspected ischemic heart disease performed coronary arteriography and elucidated the sensitivity of this method. One hour after light meal eating, TF (555 MBq) was injected intravenously at rest and after 3 minutes from injection of TF exercise or pharmacologic stress was performed. During stress Tl (111 MBq) was injected intravenously before end-point or at adequate point of pharmacologic stress. Dual energy acquisition using triple energy windows (TEW) was started after 5 minutes (early) and 4 hours (delayed) from stress. The sensitivity (Sn), specificity (Sp) and accuracy (Ac) in diagnosis of non-infarcted branches by using Tl (early)-TF (rest) and Tl (early)-Tl (delayed) were 79% vs. 53% (Sn), 78% vs. 96% (Sp) and 79% vs. 71% (Ac) respectively. Accordance of uptake score of infarcted region between TF (rest) and Tl (delayed) was 70%. In conclusion, this protocol is seemed to be useful as usual protocol for detection of myocardial ischemia and viability during about only 1 hour. (author)

Stress thallium-201 myocardial scintigraphy for the detection of individual coronary arterial lesions in patients with and without previous myocardial infarction

International Nuclear Information System (INIS)

Rigo, P.; Bailey, I.K.; Griffith, L.S.; Pitt, B.; Wagner, H.N. Jr.; Becker, L.C.

1981-01-01

The value of stress thallium-201 scintigraphy for detecting individual coronary arterial stenoses was analyzed in 141 patients with angiographically proved coronary artery disease, 101 with and 40 without a previous myocardial infarction. In patients without infarction, the sensitivity for detecting greater than 50 percent narrowing in the left anterior descending, the right and the left circumflex coronary artery was 66, 53 and 24 percent, respectively. In those with a previous infarction, the sensitivity for demonstrating disease in the artery corresponding to the site of infarction was 100 percent for the left anterior descending, 79 percent for the right and 63 percent for the left circumflex coronary artery. In patients with a prior anterior infarction, concomitant right or left circumflex coronary arterial lesions were detected in only 1 of 12 cases, whereas in those with previous inferior or inferolateral infarction, the sensitivity for left anterior descending coronary artery disease was 69 percent. Because of the reasonably high sensitivity for detecting left anterior descending arterial disease, irrespective of the presence and location of previous infarction, myocardial scintigraphy was useful in identifying multivessel disease in patients with a previous inferior infarction. However, because of its relative insensitivity for right or left circumflex coronary artery disease, scintigraphy proved to be a poor predictor of multivessel disease in patients with a prior anterior infarction and in patients without previous myocardial infarction

Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

International Nuclear Information System (INIS)

Noel, Cory V.; Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh; Moffett, Brady

2017-01-01

Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

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Noel, Cory V. [Baylor College of Medicine, Department of Pediatric Cardiology, Houston, TX (United States); Texas Children' s Hospital, Department of Pediatric Cardiology, Houston, TX (United States); Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Moffett, Brady [Texas Children' s Hospital, Department of Pharmacology, Houston, TX (United States)

2017-03-15

Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

SPECT Myocardial Blood Flow Quantitation Concludes Equivocal Myocardial Perfusion SPECT Studies to Increase Diagnostic Benefits.

Science.gov (United States)

Chen, Lung-Ching; Lin, Chih-Yuan; Chen, Ing-Jou; Ku, Chi-Tai; Chen, Yen-Kung; Hsu, Bailing

2016-01-01

Recently, myocardial blood flow quantitation with dynamic SPECT/CT has been reported to enhance the detection of coronary artery disease in human. This advance has created important clinical applications to coronary artery disease diagnosis and management for areas where myocardial perfusion PET tracers are not available. We present 2 clinical cases that undergone a combined test of 1-day rest/dipyridamole-stress dynamic SPECT and ECG-gated myocardial perfusion SPECT scans using an integrated imaging protocol and demonstrate that flow parameters are capable to conclude equivocal myocardial perfusion SPECT studies, therefore increasing diagnostic benefits to add value in making clinical decisions.

Abnormal tibiofemoral contact stress and its association with altered kinematics after center-center anterior cruciate ligament reconstruction: an in vitro study.

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Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas

2013-04-01

Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the anterior cruciate ligament (ACL)-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics after ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect the kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress after ACL reconstruction? Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics after ACL reconstruction. Controlled laboratory study. Clinical tests of anterior and rotational stability were simulated on 11 cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single-bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau, and mean contact stress was calculated regionally. ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however, contact stress abnormalities remained. On average, kinematics were overconstrained after ACL reconstruction (≤1.8 mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in abduction/adduction and medial-lateral translation in response to combined moments, and anterior-posterior translation, medial-lateral translation, and axial rotation in response to an anterior load were associated with abnormal mean contact

Myocardial ischemia in hypertrophic cardiomyopathy; Isquemia miocardica na cardiomiopatia hipertrofica

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Lima Filho, Moyses de Oliveira; Figueiredo, Geraldo L.; Simoes, Marcus V.; Pyntia, Antonio O.; Marin Neto, Jose Antonio [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Div. de Cardiologia

2000-08-01

Myocardial ischemia in hypertrophic cardiomyopathy is multifactorial and explains the occurrence of angina, in about 50% of patients. The pathophysiology of myocardial ischemia may be explained by the increase of the ventricular mass and relative paucity of the coronary microcirculation; the elevated ventricular filling pressures and myocardial stiffness causing a compression of the coronary microvessels; the impaired coronary vasodilator flow reserve caused by anatomic and functional abnormalities; and the systolic compression of epicardial vessel (myocardial bridges). Myocardial ischemia must be investigated by perfusion scintigraphic methods since its presence influences the prognosis and has relevant clinical implications for management of patients. Patients with hypertrophic cardiomyopathy and documented myocardial ischemia usually need to undergo invasive coronary angiography to exclude the presence of concomitant atherosclerotic coronary disease. (author)

Incidental finding of breast cancer during myocardial perfusion imaging - a case study

International Nuclear Information System (INIS)

Maglica, Deanna L.

2009-01-01

Full text: There are many incidences in Nuclear Medicine where incidental findings of pathologies other than those under investigation are found. This is mainly due to the non-specific biodistribution of the radiopharmaceuticals throughout the body. Sestamibi is one such agent that can be used for multi-imaging purposes, such as cardiac, parathyroid and carcinoma imaging. A female patient with a known history of cardiac disease presented to our department for a myocardial perfusion stress rest study. Dipryridamole was used instead of an exercise test due to leg pain and poor patient mobility. 450MBq of 99mTc- Sestamibi was injected into the patient during stress and a further IOOOMBq of 99mTc-Sestamibi during rest approximately three hours later. Post stress/rest images illustrated not only a small inferolateral infarct, but also an abnormal focus of increased activity in the right breast in the lower outer quadrant. Knowing 99mTc-Sestamibi to have a high affinity to carcinoma cells, the abnormal focal uptake was correctly diagnosed as a breast cancer malignancy. Breast cancer was confirmed on mammography and the patient underwent breast surgery, chemotherapy and radiation therapy. This case highlights the importance of thoroughly checking all cardiac SPECT 99mTc-Sestamibi cine images for incidental findings of other pathologies.

Significance of collateral circulation on peri-infarct zone: assessment with stress thallium-201 scintigraphy

International Nuclear Information System (INIS)

Imamura, T.; Araki, H.; Fukuyama, T.; Maruoka, Y.; Ootsubo, H.; Nakamura, M.; Koiwaya, Y.; Tanaka, K.

1986-01-01

To evaluate the significance of collateral circulation on peri-infarct zone, stress myocardial scintigraphy and contrast left ventriculography (LVG) were performed in 38 patients with recent myocardial infarction (MI). All patients had at least one completely occluded coronary artery corresponding to the infarct area. In patients with good collaterals, stress induced transient enlargement of the perfusion defect, however, in those with poor or no collaterals the enlargement did not occur (p less than 0.05). Wall motion abnormality on LVG was significantly milder in the former patients than in the latter (p less than 0.001). Transient enlargement of the perfusion defect after stress and milder left ventricular asynergy were more frequently observed in patients with anterior MI and good collaterals. These observations indicate that good collaterals may keep some myocardium in the peri-infarct zone viable

Value and limitations of segmental analysis of stress thallium myocardial imaging for localization of coronary artery disease

International Nuclear Information System (INIS)

Rigo, P.; Bailey, I.K.; Griffith, L.S.C.; Pitt, B.; Borow, R.D.; Wagner, H.N.; Becker, L.C.

1980-01-01

This study was done to determine the value of thallium-201 myocardial scintigraphic imaging (MSI) for identifying disease in the individual coronary arteries. Segmental analysis of rest and stress MSI was performed in 133 patients with ateriographically proved coronary artery disease (CAD). Certain scintigraphic segments were highly specific (97 to 100%) for the three major coronary arteries: anterior wall and septum for the left anterior descending (LAD) coronary artery; the inferior wall for the right coronary artery (RCA); and the proximal lateral wall for the circumflex (LCX) artery. Perfusion defects located in the anterolateral wall in the anterior view were highly specific for proximal disease in the LAD involving the major diagonal branches, but this was not true for septal defects. The apical segments were not specific for any of the three major vessels. Although MSI was abnormal in 89% of these patients with CAD, it was less sensitive for identifying individual vessel disease: 63% for LAD, 50% for RCA, and 21% for LCX disease (narrowings > = 50%). Sensitivity increased with the severity of stenosis, but even for 100% occlusions was only 87% for LAD, 58% for RCA and 38% for LCX. Sensitivity diminished as the number of vessels involved increased: with single-vessel disease, 80% of LAD, 54% of RAC and 33% of LCX lesions were detected, but in patients with triple-vessel disease, only 50% of LAD, 50% of RCA and 16% of LCX lesions were identified. Thus, although segmented analysis of MSI can identify disease in the individual coronary arteries with high specificity, only moderate sensitivity is achieved, reflecting the tendency of MSI to identify only the most severely ischemic area among several that may be present in a heart. Perfusion scintigrams display relative distributions rather than absolute values for myocardial blood flow

Doxorubicin induced myocardial injury is exacerbated following ischaemic stress via opening of the mitochondrial permeability transition pore

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Gharanei, M.; Hussain, A. [Department of Biomolecular and Sport Sciences, Coventry University, Cox Street, Coventry, CV1 5FB (United Kingdom); Janneh, O. [Department of Biomolecular and Sport Sciences, Coventry University, Cox Street, Coventry, CV1 5FB (United Kingdom); Pharmacology Research Laboratories, 70, Pembroke Place, The University of Liverpool, Liverpool. L69 3GF (United Kingdom); Maddock, H.L., E-mail: h.maddock@coventry.ac.uk [Department of Biomolecular and Sport Sciences, Coventry University, Cox Street, Coventry, CV1 5FB (United Kingdom)

2013-04-15

Chemotherapeutic agents such as doxorubicin are known to cause or exacerbate cardiovascular cell death when an underlying heart condition is present. However, the mechanism of doxorubicin-induced cardiotoxicity is unclear. Here we assess the cardiotoxic effects of doxorubicin in conditions of myocardial ischaemia reperfusion and the mechanistic basis of protection, in particular the role of the mitochondrial permeability transition pore (mPTP) in such protection. The effects of doxorubicin (1 μM) ± cyclosporine A (CsA, 0.2 μM; inhibits mPTP) were investigated in isolated male Sprague–Dawley rats using Langendorff heart and papillary muscle contraction models subjected to simulated ischaemia and reperfusion injury. Isolated rat cardiac myocytes were used in an oxidative stress model to study the effects of drug treatment on mPTP by confocal microscopy. Western blot analysis evaluated the effects of drug treatment on p-Akt and p-Erk 1/2 levels. Langendorff and the isometric contraction models showed a detrimental effect of doxorubicin throughout reperfusion/reoxygenation as well as increased p-Akt and p-Erk levels. Interestingly, CsA not only reversed the detrimental effects of doxorubicin, but also reduced p-Akt and p-Erk levels. In the sustained oxidative stress assay to study mPTP opening, doxorubicin decreased the time taken to depolarization and hypercontracture, but these effects were delayed in the presence of CsA. Collectively, our data suggest for the first that doxorubicin exacerbates myocardial injury in an ischaemia reperfusion model. If the inhibition of mPTP ameliorates the cardiotoxic effects of doxorubicin, then more selective inhibitors of mPTP should be further investigated for their utility in patients receiving doxorubicin. - Highlights: ► Doxorubicin exacerbates myocardial ischaemia reperfusion injury. ► Co-treatment with CsA protects against doxorubicin induced myocardial injury. ► CsA delays doxorubicin induced mPTP opening in laser

Doxorubicin induced myocardial injury is exacerbated following ischaemic stress via opening of the mitochondrial permeability transition pore

International Nuclear Information System (INIS)

Gharanei, M.; Hussain, A.; Janneh, O.; Maddock, H.L.

2013-01-01

Chemotherapeutic agents such as doxorubicin are known to cause or exacerbate cardiovascular cell death when an underlying heart condition is present. However, the mechanism of doxorubicin-induced cardiotoxicity is unclear. Here we assess the cardiotoxic effects of doxorubicin in conditions of myocardial ischaemia reperfusion and the mechanistic basis of protection, in particular the role of the mitochondrial permeability transition pore (mPTP) in such protection. The effects of doxorubicin (1 μM) ± cyclosporine A (CsA, 0.2 μM; inhibits mPTP) were investigated in isolated male Sprague–Dawley rats using Langendorff heart and papillary muscle contraction models subjected to simulated ischaemia and reperfusion injury. Isolated rat cardiac myocytes were used in an oxidative stress model to study the effects of drug treatment on mPTP by confocal microscopy. Western blot analysis evaluated the effects of drug treatment on p-Akt and p-Erk 1/2 levels. Langendorff and the isometric contraction models showed a detrimental effect of doxorubicin throughout reperfusion/reoxygenation as well as increased p-Akt and p-Erk levels. Interestingly, CsA not only reversed the detrimental effects of doxorubicin, but also reduced p-Akt and p-Erk levels. In the sustained oxidative stress assay to study mPTP opening, doxorubicin decreased the time taken to depolarization and hypercontracture, but these effects were delayed in the presence of CsA. Collectively, our data suggest for the first that doxorubicin exacerbates myocardial injury in an ischaemia reperfusion model. If the inhibition of mPTP ameliorates the cardiotoxic effects of doxorubicin, then more selective inhibitors of mPTP should be further investigated for their utility in patients receiving doxorubicin. - Highlights: ► Doxorubicin exacerbates myocardial ischaemia reperfusion injury. ► Co-treatment with CsA protects against doxorubicin induced myocardial injury. ► CsA delays doxorubicin induced mPTP opening in laser

Myocardial Contrast Agents – Safety Considerations and Clinical Efficacy in Stress Echocardiography

Directory of Open Access Journals (Sweden)

Maier Anca

2016-11-01

Full Text Available Transthoracic echocardiographic examination is known to be a safe, non-invasive and reproducible method, used in every day clinical practice to obtain important information about cardiac structure and function. Unfortunately, a significant proportion of studies have highlighted the considerable technically difficultly in producing diagnostic images due to a poor acoustic window and more than 33% of patients undergoing stress echocardiography have suboptimal echocardiographic images. All these limitations have led to the use of contrast agents to improve the quality of standard ultrasound examination to provide a better delineation of left ventricle endocardial borders or to obtain information that cannot be achieved by using standard echocardiography, such as assessing myocardial microcirculation and therefore perfusion. This paper sought to review the clinical efficacy and safety of ultrasound contrast agents focusing on stress echocardiography.

Effects of Intensive Statin Therapy on Left Ventricular Function in Patients with Myocardial Infarction and Abnormal Glucose Tolerance

DEFF Research Database (Denmark)

Auscher, Søren; Løgstrup, Brian Bridal; Møller, Jacob Eifer

2017-01-01

OBJECTIVES: Abnormal glucose tolerance in patients with acute myocardial infarction (AMI) is associated with greater mortality and adverse cardiovascular effects. As statins possess a range of beneficial pleiotropic effects on the cardiovascular system, we sought to assess the cardioprotective...... effects of statins on left ventricular function in patients with AMI in relation to glycometabolic state. METHODS: In a prospective, randomized trial, 140 patients with AMI were randomized to intensive statin therapy receiving statin loading with 80 mg of rosuvastatin followed by 40 mg daily or standard...... statin therapy. Patients were assessed with an oral glucose tolerance test and their left ventricular (LV) function was assessed with speckle-tracking echocardiography measuring regional longitudinal systolic strain (RLSS) in the infarct area. RESULTS: Overall RLSS in the infarct area improved by a mean...

Studies on clinical significance of exercise-induced ST-segment depression at non-infarct-related leads in the patients with prior myocardial infarction using the stress scintigraphy

International Nuclear Information System (INIS)

Ohkubo, Toshitaka

1988-01-01

Stress Tl-201 myocardial imaging and stress radionuclide ventriculography were performed in a total of 67 patients with prior myocardial infarction (MI) to assess the clinical significance of exercise induced ST-segment depression at non-infarct-related leads on ECG during the chronic stage. The patients consisted of 12 with inferior MI with single vessel disease (SVD) that showed no precordial ST-segment depression; 7 with inferior MI with SVD accompanied by precordial ST-segment depression; 13 with inferior MI with multivessel disease (MVD); 20 with anterior MI with SVD that showed no inferior ST-segment depression; 4 with anterior MI with SVD accompanied by inferior ST-segment depression; and 11 with anterior MI with MVD. In cases of SVD, the incidence of ST-segment depression at non-infarct-related leads was higher for inferior MI (36.8%) than anterior MI (16.7%). Myocardial imaging revealed large infarct and infarct extending into the inferoseptal wall of the left ventricle (LV) in cases of exercise induced precordial ST-segment depression; and infarct extending into the lateral wall of LV in cases of exercise induced inferior ST-segment depression. In detecting MVD, stress Tl-201 myocardial imaging was superior to exercise electrocardiography and stress radionuclide ventriculography, but this was not statistically significant. Prognostic value of error rate for detecting MVD was significantly improved with a discriminant analysis. Exercise induced ST-segment depression on ECG should be of clinical significance in reflecting myocardial ischemia around an infarcted area. (Namekawa, K)

Myocardial bridges: their clinical implications and prognostic signs

International Nuclear Information System (INIS)

Wasfy, I.; Nouh, Mohamed S.; Foda, M.; Al-Shemairi, M.; Al-Sedeeki, A.

1996-01-01

Among 980 consecutive selective coronary angiograms performed, nine patients had myocardial bridges of the left anterior descending (LAD) coronary artery. The overall prevalence of myocardial bridge was 0.92%. Among these patients, three patients had coronary artery disease, while six cases were isolated myocardial muscle bridges. With respect to functional abnormality, three had grade III milking effect, three had grade II and three had grade I milking effect. The indications for coronary angiograms were typical chest pain in seven cases and a typical chest pain in two cases. Their clinical and laboratory investigations are presented with literature review. (author)

Quantitative comparison of dobutamine and exercise stress 99mTc-MIBI myocardial SPECT in diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Wu, H.; Liu, H.C.

2002-01-01

Aim: To compare the value of dobutamine and exercise stress 99m Tc-MIBI myocardial imaging in diagnosis of coronary heart disease (CHD). Material and Methods: The subjects included twenty-one patients, in whom 18 were suspected with CHD and 3 were clinically diagnosed with myocardial infarction. The final diagnosis in all patients was confirmed by coronary angiography. Both dobutamine stress (DOB-ST) and bicycle exercise stress (EX-ST) 99m Tc-MIBI myocardial perfusion SPECT were undertaken in every patient. The two stress imaging in one patient were performed within three days. Results: Twenty-four vessels in fourteen patients were diagnosed with coronary artery disease. There were no significant difference between DOB-ST and EX-ST in overall sensitivity (92.8% vs 92.8%), specificity (71.4 vs 85.7%), positive predictive value (86.7% vs 92.9%) and negative predictive value (83.3 vs 85.7%). There were also no significant difference in the sensitivity and specificity for detecting single or multiple vessel disease and for detecting specified vessel lesions (LDA, RCA, LCX). However, in 69 segments which related to the diseased vessels DOB-ST revealed 47 ischemic segments and EX-ST found 30 ischemic segments (P<0.05). The ischemic size which was expressed by the percentage of black-out area in polar map were bigger in DOB-ST image than that in EX-ST image (22.8±11.4% vs 17.5±12.3%, P<0.01) and, average radioactivity uptake ratio of ischemic region in DOB-ST image was lower than that in EX-ST image (43.2±13.8% vs 57.4±14.6%, P<0.01). Conclusion: DOB-ST demonstrated similar diagnostic efficacy to EX-ST in detecting coronary artery disease, thus it may be a feasible intervention for myocardial perfusion imaging. Whether DOB-ST is more sensitive to detect mild ischemia than EX-ST remains to be further investigated

Reversible Stress Cardiomyopathy Presenting as Acute Coronary Syndrome with Elevated Troponin in the Absence of Regional Wall Motion Abnormalities: A Forme Fruste of Stress Cardiomyopathy?

Directory of Open Access Journals (Sweden)

Mahesh Anantha Narayanan

2014-01-01

Full Text Available We present a case of reversible stress cardiomyopathy in a surgical patient, described here as a forme fruste due to its atypical features. It is important to recognize such unusual presentation of stress cardiomyopathy that mimics acute coronary syndrome. Stress cardiomyopathy commonly presents as acute coronary syndrome and is characterized by typical or atypical variants of regional wall motion abnormalities. We report a 60-year-old Caucasian male with reversible stress cardiomyopathy following a sternal fracture fixation. Although the patient had several typical features of stress cardiomyopathy including physical stress, ST-segment elevation, elevated cardiac biomarkers and normal epicardial coronaries, there were few features that were atypical, including unusual age, gender, absence of regional wall motion abnormalities, high lateral ST elevation, and high troponin-ejection fraction product. In conclusion, this could represent a forme fruste of stress cardiomyopathy.

Gated-SPECT myocardial scintigraphy in left bundle branch block: A study in patients with and without coronary artery disease

International Nuclear Information System (INIS)

Falcao, A.M.; Moffa, P.J.; Chalela, W.A.; Soares, J.; Oliveira, C.G.; Kreling, J.C.; Ferreira, B.A.; Uchida, A.H.; Meneghetti, J.C.

2002-01-01

Introduction: Myocardial perfusion scintigraphy (MPS) is a non-invasive method helpful for evaluating coronary heart disease. In left bundle branch block (LBBB), the myocardial scintigraphy frequently reveals septal abnormalities in the absence of coronary artery disease (CAD) and gives rise to 'false-positive' results in patients (pts) with suspected CAD. The purpose of this study was to assess the diagnostic role of ECG-gated SPECT in pts with complete LBBB, with and without known CAD. Methods. This study included 46 pts, 29 women (63%), with mean age 63.8 ± 11.6yr, divided into two groups: Group 1 (n=21 pts) with LBBB and CAD angiographically confirmed and Group 2 (n=25 pts) with LBBB and normal coronangiography. All pts underwent MPS at rest and two stress tests - dipyridamole (DIP) and treadmill exercise test (ET) with Bruce protocol. Myocardial perfusion, wall motility and wall thickening were analyzed qualitatively by consensus of two observers in anterior, septal, inferior, lateral and apical myocardial segments. Scores were attributed to: perfusion as normal, reversible or fixed defects; motility as normal, hypokinesia, akinesia or dyskinesia and thickening if present or absent. The left ventricle ejection fraction (LVEF) was automatically calculated from the ECG-gated SPECT. Results: The comparative analysis between groups 1 and 2 for both stresses (DIP and ET) for the parameters analyzed in the myocardial segments are presented: LVEF at rest, ET and DIP show statistically significant differences between groups 1 and 2 (p<0.0001). Conclusion: In the anterior and septal segments, only septal thickening was capable of differentiating between LBBB with and without CAD, independent of the kind of stress. In the other segments there was no influence of disturbance conduction for the perfusion analysis

Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a {sup 13}NH{sub 3} gated PET study

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Sciagra, Roberto; Calabretta, Raffaella; Passeri, Alessandro; Castello, Angelo; Pupi, Alberto [University of Florence, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Cipollini, Fabrizio [University of Florence, Department of Statistics, Florence (Italy); Cecchi, Franco; Olivotto, Iacopo [Careggi University Hospital, Referral Centre for Myocardial Diseases, Florence (Italy)

2017-05-15

Ischemia in hypertrophic cardiomyopathy (HCM) is caused by coronary microvascular dysfunction (CMD), which is detected by measuring myocardial blood flow (MBF) with PET. Whether CMD may be associated with ischemic left ventricular (LV) dysfunction is unclear. We therefore assessed LV ejection fraction (EF) reserve in HCM patients undergoing dipyridamole (Dip) PET. Resting and stress {sup 13}NH{sub 3} dynamic as well as gated PET were performed in 34 HCM patients. Segmental MBF and transmural perfusion gradient (TPG = subendocardial / subepicardial MBF) were assessed. LVEF reserve was considered abnormal if Dip LVEF decreased more than 5 units as compared to rest. Eighteen patients had preserved (group A) and 16 abnormal LVEF reserve (group B; range -7 to -32). Group B patients had greater wall thickness than group A, but resting volumes, LVEF, resting and Dip MBF, and myocardial flow reserve were similar. Group B had slightly higher summed stress score and summed difference score in visual analysis than group A, and a significantly higher summed stress wall motion score. In group B, resting TPG was slightly lower (1.31 ± 0.29 vs. 1.37 ± 0.34, p <0.05), and further decreased after Dip, whilst in group A it increased (B = 1.20 ± 0.39, p < 0.0001 vs. rest and vs. A = 1.40 ± 0.43). The number of segments per patient with TPG <1 was higher than in group A (p < 0.001) and was a significant predictor of impaired LVEF reserve (OR 1.86, p < 0.02), together with wall thickness (OR 1.3, p < 0.02). Abnormal LVEF response is common in HCM patients following Dip, and is related to abnormal TPG, suggesting that subendocardial ischemia might occur under Dip and cause transient LV dysfunction. Although in vivo this effect may be hindered by the adrenergic drive associated with effort, these findings may have relevance in understanding exercise limitation and heart failure symptoms in HCM. (orig.)

Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

International Nuclear Information System (INIS)

Sutherland, G.R.; Driedger, A.A.; Holliday, R.L.; Cheung, H.W.; Sibbald, W.J.

1983-01-01

Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly lower (31 +/- 11% and 47 +/- 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 +/- 8% and 58 +/- 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle

Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation

International Nuclear Information System (INIS)

Joki, Nobuhiko; Hase, Hiroki; Kawano, Yuhei; Nakamura, Satoko; Nakajima, Kenichi; Hatta, Tsuguru; Nishimura, Shigeyuki; Moroi, Masao; Nakagawa, Susumu; Kasai, Tokuo; Kusuoka, Hideo; Takeishi, Yasuchika; Momose, Mitsuru; Takehana, Kazuya; Nanasato, Mamoru; Yoda, Shunichi; Nishina, Hidetaka; Matsumoto, Naoya; Nishimura, Tsunehiko

2014-01-01

Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear. The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) 2 without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with 99m Tc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration. Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0-3, 4-7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction. MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys. (orig.)

Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation

Energy Technology Data Exchange (ETDEWEB)

Joki, Nobuhiko; Hase, Hiroki [Toho University Ohashi Medical Center, Department of Nephrology, Tokyo (Japan); Kawano, Yuhei; Nakamura, Satoko [National Cerebral and Cardiovascular Center, Division of Hypertension and Nephrology, Osaka (Japan); Nakajima, Kenichi [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Hatta, Tsuguru [Hatta Medical Office of Internal Medicine, Kyoto (Japan); Nishimura, Shigeyuki [Saitama Medical University International Medical Center, Saitama (Japan); Moroi, Masao [Toho University Ohashi Medical Center, Department of Cardiology, Tokyo (Japan); Nakagawa, Susumu [Saiseikai Central Hospital, Department of Cardiology, Tokyo (Japan); Kasai, Tokuo [Tokyo Medical University Hachioji Medical Center, Tokyo (Japan); Kusuoka, Hideo [Osaka National Hospital, Osaka (Japan); Takeishi, Yasuchika [Fukushima Medical University, Department of Cardiology and Hematology, Fukushima (Japan); Momose, Mitsuru [Tokyo Women' s Medical University, Department of Diagnostic Imaging and Nuclear Medicine, Tokyo (Japan); Takehana, Kazuya [Kansai Medical University, Department of Cardiology, Osaka (Japan); Nanasato, Mamoru [Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya (Japan); Yoda, Shunichi [Nihon University Itabashi Hospital, Department of Cardiology, Tokyo (Japan); Nishina, Hidetaka [Tsukuba Medical Center Hospital, Department of Cardiology, Tsukuba (Japan); Matsumoto, Naoya [Suruga-dai Nihon University Hospital, Department of Cardiology, Tokyo (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto (Japan)

2014-09-15

Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear. The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) < 50 ml/min per 1.73{sup 2} without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with {sup 99m}Tc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration. Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0-3, 4-7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction. MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys. (orig.)

Navigator-gated 3D blood oxygen level-dependent CMR at 3.0-T for detection of stress-induced myocardial ischemic reactions.

Science.gov (United States)

Jahnke, Cosima; Gebker, Rolf; Manka, Robert; Schnackenburg, Bernhard; Fleck, Eckart; Paetsch, Ingo

2010-04-01

This study determined the value of navigator-gated 3-dimensional blood oxygen level-dependent (BOLD) cardiac magnetic resonance (CMR) at 3.0-T for the detection of stress-induced myocardial ischemic reactions. Although BOLD CMR has been introduced for characterization of myocardial oxygenation status, previously reported CMR approaches suffered from a low signal-to-noise ratio and motion-related artifacts with impaired image quality and a limited diagnostic value in initial patient studies. Fifty patients with suspected or known coronary artery disease underwent CMR at 3.0-T followed by invasive X-ray angiography within 48 h. Three-dimensional BOLD images were acquired during free breathing with full coverage of the left ventricle in a short-axis orientation. The BOLD imaging was performed at rest and under adenosine stress, followed by stress and rest first-pass perfusion and delayed enhancement imaging. Quantitative coronary X-ray angiography (QCA) was used for coronary stenosis definition (diameter reduction > or =50%). The BOLD and first-pass perfusion images were semiquantitatively evaluated (for BOLD imaging, signal intensity differences between stress and rest [DeltaSI]; for perfusion imaging, myocardial perfusion reserve index [MPRI]). The image quality of BOLD CMR at rest and during adenosine stress was considered good to excellent in 90% and 84% of the patients, respectively. The DeltaSI measurements differed significantly between normal myocardium, myocardium supplied by a stenotic coronary artery, and infarcted myocardium (p exogenous contrast-enhancement studies. Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Myocardial perfusion imaging for detection of silent myocardial ischemia

International Nuclear Information System (INIS)

Beller, G.A.

1988-01-01

Despite the widespread use of the exercise stress test in diagnosing asymptomatic myocardial ischemia, exercise radionuclide imaging remains useful for detecting silent ischemia in numerous patient populations, including those who are totally asymptomatic, those who have chronic stable angina, those who have recovered from an episode of unstable angina or an uncomplicated myocardial infarction, and those who have undergone angioplasty or received thrombolytic therapy. Studies show that thallium scintigraphy is more sensitive than exercise electrocardiography in detecting ischemia, i.e., in part, because perfusion defects occur more frequently than ST depression and before angina in the ischemic cascade. Thallium-201 scintigraphy can be performed to differentiate a true- from a false-positive exercise electrocardiographic test in patients with exercise-induced ST depression and no angina. The development of technetium-labeled isonitriles may improve the accuracy of myocardial perfusion imaging. 11 references

Safety of intravenous dipyridamole thallium myocardial perfusion imaging: experience in 435 patients

International Nuclear Information System (INIS)

Dubrey, S.W.; Noble, M.I.M.; Jewkes, R.F.; Bomanji, J.B.

1993-01-01

Dipyridamole stress 201 T1 scintigraphy is widely used in the investigation of myocardial ischaemia. We report our experience of adverse effects observed during this diagnostic procedure. A prospective study was undertaken of 435 consecutive patients referred to two nuclear medicine departments for assessment of myocardial perfusion. Patients were monitored prior to and following the infusion of dipyridamole. All symptomatic, haemodynamic and electrocardiographic changes were documented. No deaths occurred in this series. Adverse events were observed in 174 (40%) patients. Of these, three patients experienced 'major' adverse events (0.6%) requiring hospitalization (myocardial infarction = 1; chest pain = 1; simple partial seizure = 1). 'Moderate' adverse events occurred in 39 (8.9%) patients and required intravenous aminophylline to reverse effects (ST segment abnormalities = 26; nausea = 7; headache = 3; chest pain = 2; bronchospasm = 1; protracted vomiting = 1; diarrhoea = 1). 'Minor' adverse events were experienced by 132 (30.3%) patients and did not require aminophylline. Sixty per cent of our patients experienced no ill effects from dipyridamole given as an exercise substitute in conjunction with 201 T1 imaging. The rest had symptoms which were mostly mild, although a few patients found the experience unpleasant. Only one patient experienced a life-threatening episode. (Author)

Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses

International Nuclear Information System (INIS)

Perrin, Mathieu; Claudin, Marine; Veran, Nicolas; Morel, Olivier; Besseau, Cyril; Boutley, Henri; Djaballah, Wassila; Poussier, Sylvain; Verger, Antoine; Moulin, Frederic; Imbert, Laetitia; Karcher, Gilles; Marie, Pierre-Yves

2015-01-01

Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging. During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of 99m Tc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50 % coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10 %). Overall, 33 % of patients had abnormal MPI of which 34 % were women and 34 % were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37 % in the overall population, (2) 4.83 ± 1.56 mSv and 5 % in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80 %, respectively, while the normalcy rate was 97 %. When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations. (orig.)

Psychological stress exposure to aged mice causes abnormal feeding patterns with changes in the bout number.

Science.gov (United States)

Yamada, Chihiro; Mogami, Sachiko; Hattori, Tomohisa

2017-11-09

Stress responses are affected by aging. However, studies on stress-related changes in feeding patterns with aging subject are minimal. We investigated feeding patterns induced by two psychological stress models, revealing characteristics of stress-induced feeding patterns as "meal" and "bout" (defined as the minimum feeding behavior parameters) in aged mice. Feeding behaviors of C57BL/6J mice were monitored for 24 h by an automatic monitoring device. Novelty stress reduced the meal amount over the 24 h in both young and aged mice, but as a result of a time course study it was persistent in aged mice. In addition, the decreased bout number was more pronounced in aged mice than in young mice. The 24-h meal and bout parameters did not change in either the young or aged mice following water avoidance stress (WAS). However, the meal amount and bout number increased in aged mice for 0-6 h after WAS exposure but remained unchanged in young mice. Our findings suggest that changes in bout number may lead to abnormal stress-related feeding patterns and may be one tool for evaluating eating abnormality in aged mice.

Fisetin Confers Cardioprotection against Myocardial Ischemia Reperfusion Injury by Suppressing Mitochondrial Oxidative Stress and Mitochondrial Dysfunction and Inhibiting Glycogen Synthase Kinase 3β Activity

Directory of Open Access Journals (Sweden)

Karthi Shanmugam

2018-01-01

Full Text Available Acute myocardial infarction (AMI is the leading cause of morbidity and mortality worldwide. Timely reperfusion is considered an optimal treatment for AMI. Paradoxically, the procedure of reperfusion can itself cause myocardial tissue injury. Therefore, a strategy to minimize the reperfusion-induced myocardial tissue injury is vital for salvaging the healthy myocardium. Herein, we investigated the cardioprotective effects of fisetin, a natural flavonoid, against ischemia/reperfusion (I/R injury (IRI using a Langendorff isolated heart perfusion system. I/R produced significant myocardial tissue injury, which was characterized by elevated levels of lactate dehydrogenase and creatine kinase in the perfusate and decreased indices of hemodynamic parameters. Furthermore, I/R resulted in elevated oxidative stress, uncoupling of the mitochondrial electron transport chain, increased mitochondrial swelling, a decrease of the mitochondrial membrane potential, and induction of apoptosis. Moreover, IRI was associated with a loss of the mitochondrial structure and decreased mitochondrial biogenesis. However, when the animals were pretreated with fisetin, it significantly attenuated the I/R-induced myocardial tissue injury, blunted the oxidative stress, and restored the structure and function of mitochondria. Mechanistically, the fisetin effects were found to be mediated via inhibition of glycogen synthase kinase 3β (GSK3β, which was confirmed by a biochemical assay and molecular docking studies.

Fisetin Confers Cardioprotection against Myocardial Ischemia Reperfusion Injury by Suppressing Mitochondrial Oxidative Stress and Mitochondrial Dysfunction and Inhibiting Glycogen Synthase Kinase 3β Activity.

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Shanmugam, Karthi; Ravindran, Sriram; Kurian, Gino A; Rajesh, Mohanraj

2018-01-01

Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality worldwide. Timely reperfusion is considered an optimal treatment for AMI. Paradoxically, the procedure of reperfusion can itself cause myocardial tissue injury. Therefore, a strategy to minimize the reperfusion-induced myocardial tissue injury is vital for salvaging the healthy myocardium. Herein, we investigated the cardioprotective effects of fisetin, a natural flavonoid, against ischemia/reperfusion (I/R) injury (IRI) using a Langendorff isolated heart perfusion system. I/R produced significant myocardial tissue injury, which was characterized by elevated levels of lactate dehydrogenase and creatine kinase in the perfusate and decreased indices of hemodynamic parameters. Furthermore, I/R resulted in elevated oxidative stress, uncoupling of the mitochondrial electron transport chain, increased mitochondrial swelling, a decrease of the mitochondrial membrane potential, and induction of apoptosis. Moreover, IRI was associated with a loss of the mitochondrial structure and decreased mitochondrial biogenesis. However, when the animals were pretreated with fisetin, it significantly attenuated the I/R-induced myocardial tissue injury, blunted the oxidative stress, and restored the structure and function of mitochondria. Mechanistically, the fisetin effects were found to be mediated via inhibition of glycogen synthase kinase 3 β (GSK3 β ), which was confirmed by a biochemical assay and molecular docking studies.

Cardiac function and myocardial perfusion immediately following maximal treadmill exercise inside the MRI room

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Ballinger Michelle R

2008-01-01

Full Text Available Abstract Treadmill exercise stress testing is an essential tool in the prevention, detection, and treatment of a broad spectrum of cardiovascular disease. After maximal exercise, cardiac images at peak stress are typically acquired using nuclear scintigraphy or echocardiography, both of which have inherent limitations. Although CMR offers superior image quality, the lack of MRI-compatible exercise and monitoring equipment has prevented the realization of treadmill exercise CMR. It is critical to commence imaging as quickly as possible after exercise to capture exercise-induced cardiac wall motion abnormalities. We modified a commercial treadmill such that it could be safely positioned inside the MRI room to minimize the distance between the treadmill and the scan table. We optimized the treadmill exercise CMR protocol in 20 healthy volunteers and successfully imaged cardiac function and myocardial perfusion at peak stress, followed by viability imaging at rest. Imaging commenced an average of 30 seconds after maximal exercise. Real-time cine of seven slices with no breath-hold and no ECG-gating was completed within 45 seconds of exercise, immediately followed by stress perfusion imaging of three short-axis slices which showed an average time to peak enhancement within 57 seconds of exercise. We observed a 3.1-fold increase in cardiac output and a myocardial perfusion reserve index of 1.9, which agree with reported values for healthy subjects at peak stress. This study successfully demonstrates in-room treadmill exercise CMR in healthy volunteers, but confirmation of feasibility in patients with heart disease is still needed.

Time course evaluation of myocardial perfusion after reperfusion therapy by 99mTc-tetrofosmin SPECT in patients with acute myocardial infarction.

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Tanaka, R; Nakamura, T

2001-09-01

Myocardial perfusion imaging with 99mTc-labeled agents immediately after reperfusion therapy can underestimate myocardial salvage. It is also conceivable that delayed imaging is useful for assessing the risk area. However, to our knowledge, very few studies have sequentially evaluated these image changes. We conducted 99mTc-tetrofosmin (TF) and 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) SPECT before and after reperfusion to treat acute myocardial infarction and quantified changes in TF myocardial accumulation and reverse redistribution. Seventeen patients with a first myocardial infarction underwent successful reperfusion. We examined SPECT images obtained at the onset (preimage), those acquired 30 min (early image) and 6 h (delayed image) after TF injection, and images acquired 1, 4, 7, and 20 d after reperfusion (post-1-d, post-4-d, post-7-d, and post-20-d image, respectively). We also examined BMIPP SPECT images after 7 +/- 1.8 d (BMIPP image). Polar maps were divided into 48 segments to calculate percentage uptake, and time course changes in segment numbers below 60% were observed as abnormal area. Moreover, cardiac function was analyzed by gated TF SPECT on 1 and 20 d after reperfusion. In reference to the abnormal area on the early images, the post-1-d image was significantly improved compared with the preimage (P < 0.01) as was the post-7-d image compared with the post-1-d and post-4-d images (P < 0.05, respectively). However, post-20-d and post-7-d images did not significantly differ. Therefore, the improvement in myocardial accumulation reached a plateau 7 d after reperfusion. On the other hand, the abnormal area on the delayed images was significantly greater (P < 0.01) compared with that on the early images from 4 to 20 d after reperfusion, as the value was essentially constant. The correlations of the abnormal area between the preimage and the post-7-d delayed image, the preimage and the BMIPP image, and the post-7-d delayed image and the

Low Intensity Physical Exercise Attenuates Cardiac Remodeling and Myocardial Oxidative Stress and Dysfunction in Diabetic Rats

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C. Gimenes

2015-01-01

Full Text Available We evaluated the effects of a low intensity aerobic exercise protocol on cardiac remodeling and myocardial function in diabetic rats. Wistar rats were assigned into four groups: sedentary control (C-Sed, exercised control (C-Ex, sedentary diabetes (DM-Sed, and exercised diabetes (DM-Ex. Diabetes was induced by intraperitoneal injection of streptozotocin. Rats exercised for 9 weeks in treadmill at 11 m/min, 18 min/day. Myocardial function was evaluated in left ventricular (LV papillary muscles and oxidative stress in LV tissue. Statistical analysis was given by ANOVA or Kruskal-Wallis. Echocardiogram showed diabetic groups with higher LV diastolic diameter-to-body weight ratio and lower posterior wall shortening velocity than controls. Left atrium diameter was lower in DM-Ex than DM-Sed (C-Sed: 5.73±0.49; C-Ex: 5.67±0.53; DM-Sed: 6.41±0.54; DM-Ex: 5.81±0.50 mm; P<0.05 DM-Sed vs C-Sed and DM-Ex. Papillary muscle function was depressed in DM-Sed compared to C-Sed. Exercise attenuated this change in DM-Ex. Lipid hydroperoxide concentration was higher in DM-Sed than C-Sed and DM-Ex. Catalase and superoxide dismutase activities were lower in diabetics than controls and higher in DM-Ex than DM-Sed. Glutathione peroxidase activity was lower in DM-Sed than C-Sed and DM-Ex. Conclusion. Low intensity exercise attenuates left atrium dilation and myocardial oxidative stress and dysfunction in type 1 diabetic rats.

Comparison of myocardial function between post-menopausal and pre-menopausal women: evaluation by gated myocardial SPECT

International Nuclear Information System (INIS)

Hwang, K. H.; Choa, Won Sick; Yoon, Min Ki

2005-01-01

In addition to inhibiting coronary atherosclerosis, estrogen is expected to have protective effects on cardiac myocytes. We investigated the difference in myocardial functional parameters evaluated by gated myocardial SPECT after adenosine-stress between post-menopausal and pre-menopausal healthy women. This study included 22 healthy post-menopausal women (mean age: 53.0 yr) and 20 pre-menopausal women (mean age: 43.0 yr) who performed Tc-99m tetrofosmin gated myocardial SPECT after adenosine-stress. Measured hemodynamic parameters, EDV, ESV, stroke volume, EF, cardiac output and cardiac index were compared between the two groups. For comparison, similar-aged two male groups with matched numbers were also studied. There was no significant difference in hemodynamic parameters. EDV, ESV, stroke volume, EF, or cardiac output between the post-menopausal and pre-menopausal women. However, post-menopausal women have a smaller cardiac index (mean: 1.95 L/min/m2 vs 2.20 L/min/m2; p=0.045) and adenosine-induced HR increase (mean : 80.5/min vs 89.7/min ; p=0.03), compared to the pre-menopausal women. On the contrary, the two male groups of the same age range and numbers with the women groups showed no significant difference in any myocardial parameters. These results suggest that menopause may be correlated with reduced increase in cardiac index and HR increase after adenosine-stress

Comparison of myocardial function between post-menopausal and pre-menopausal women: evaluation by gated myocardial SPECT

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Hwang, K. H.; Choa, Won Sick; Yoon, Min Ki [Gachon Medical School, Gil Hospital, Incheon (Korea, Republic of)

2005-07-01

In addition to inhibiting coronary atherosclerosis, estrogen is expected to have protective effects on cardiac myocytes. We investigated the difference in myocardial functional parameters evaluated by gated myocardial SPECT after adenosine-stress between post-menopausal and pre-menopausal healthy women. This study included 22 healthy post-menopausal women (mean age: 53.0 yr) and 20 pre-menopausal women (mean age: 43.0 yr) who performed Tc-99m tetrofosmin gated myocardial SPECT after adenosine-stress. Measured hemodynamic parameters, EDV, ESV, stroke volume, EF, cardiac output and cardiac index were compared between the two groups. For comparison, similar-aged two male groups with matched numbers were also studied. There was no significant difference in hemodynamic parameters. EDV, ESV, stroke volume, EF, or cardiac output between the post-menopausal and pre-menopausal women. However, post-menopausal women have a smaller cardiac index (mean: 1.95 L/min/m2 vs 2.20 L/min/m2; p=0.045) and adenosine-induced HR increase (mean : 80.5/min vs 89.7/min ; p=0.03), compared to the pre-menopausal women. On the contrary, the two male groups of the same age range and numbers with the women groups showed no significant difference in any myocardial parameters. These results suggest that menopause may be correlated with reduced increase in cardiac index and HR increase after adenosine-stress.

The effect of water on the extra-cardiac background on Tc-99m MIBI myocardial scintigraphy

International Nuclear Information System (INIS)

Nolan, L.; Bouma, H.M.; Ellmann, A.

2004-01-01

Full text: Introduction Tc-99m MIBI (methoxy isobutyl isonitrile) scintigraphy of the heart provides information on myocardial perfusion. Stress and rest myocardial perfusion imaging is performed on patients with suspected ischaemic heart disease. Tc-99m MIBI is concentrated by the liver and excreted into the gastro intestinal tract. Interfering hepatic and intestinal activity complicates the interpretation of myocardial perfusion in the inferior wall. The intake of a fatty meal after administration of the radiopharmaceutical decreases hepatic activity but often increases intestinal activity. A simple, cheap method to decrease hepatic and intestinal activity will help to optimise the diagnostic evaluation of abnormalities in the inferior wall of the heart. Aim: The purpose of the study Is to investigate the volume effect of a full stomach induced by 400ml of water on the appearance of intestinal artifacts on stress-rest Tc-99m MIBI myocardial perfusion imaging in order to assist in the evaluation of the Inferior wall of the left ventricle. Methods: Initially a retrospective study was performed on 40 patients referred for myocardial perfusion scintigraphy. Two groups of patients were studied; in one group (group A) patients did not receive water and in the second group (group B) each patient drank 400ml of water directly before imaging. Based on the results of the retrospective study, a prospective study has been initiated. Each patient will be imaged twice after stress or during rest. During part 1 patients will abstain from water and food before imaging. In part 2, imaging will be repeated after the ingestion of 2 glasses (400mi) water and 2 slices of buttered bread. In each patient myocardial perfusion of the inferior wall will be compared with and without water and a light meal. Results: Results from the retrospective study comparing 2 groups of patients show that there is better visibility of Inferior wall perfusion of patients in group B, implying that more

Myocardial scintigraphy

International Nuclear Information System (INIS)

Bunko, Hisashi; Hisada, Kinichi

1982-01-01

Among the various methods of image diagnosis of the cardiovascular disorder, nuclear cardiology provides noninvasive means for evaluation of myocardial perfusion as well as morphological and functional informations. In this article, clinical application and image diagnosis of myocardial scintigraphy including Tl-201 myocardial perfusion scintigraphy, single photon emission computed tomography with Tl-201, acute myocardial infarction scintigraphy with Tc-99m-pyrophosphate and Ga-67 imaging of the heart, were discussed. Multiplanar imaging of the heart with Tl-201 after stress and at redistribution was the accepted method for detection and evaluation of the ischemic heart disease. Although it achieved high sensitivity and specificity for ischemic heart disease, detection of the small ischemia and quantation of the regional Tl-201 accumulation were difficult with conventional multiplanar imaging. Application of emission computed tomography improved detectability and quantitativity of the ischemia. However, 7-pinhole tomography did not increase the diagnostic accuracy significantly. It had limited clinical applicability due to poor quantitativity in spite of improved image contrast and its tomographic nature. Advantage and limitation of these tomographic imaging and multiplanar imaging were discussed. Problems and prognostic significance of pyrophosphate imaging of the acute myocardial infarction were also discussed. Visualization of the heart with Ga-67 was helpful for identification of the tumor or inflammation of the heart as well as evaluation of the effect of the therapy. (author)

Abnormal Fear Memory as a Model for Posttraumatic Stress Disorder.

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Desmedt, Aline; Marighetto, Aline; Piazza, Pier-Vincenzo

2015-09-01

For over a century, clinicians have consistently described the paradoxical co-existence in posttraumatic stress disorder (PTSD) of sensory intrusive hypermnesia and declarative amnesia for the same traumatic event. Although this amnesia is considered as a critical etiological factor of the development and/or persistence of PTSD, most current animal models in basic neuroscience have focused exclusively on the hypermnesia, i.e., the persistence of a strong fear memory, neglecting the qualitative alteration of fear memory. The latest is characterized by an underrepresentation of the trauma in the context-based declarative memory system in favor of its overrepresentation in a cue-based sensory/emotional memory system. Combining psychological and neurobiological data as well as theoretical hypotheses, this review supports the idea that contextual amnesia is at the core of PTSD and its persistence and that altered hippocampal-amygdalar interaction may contribute to such pathologic memory. In a first attempt to unveil the neurobiological alterations underlying PTSD-related hypermnesia/amnesia, we describe a recent animal model mimicking in mice some critical aspects of such abnormal fear memory. Finally, this line of argument emphasizes the pressing need for a systematic comparison between normal/adaptive versus abnormal/maladaptive fear memory to identify biomarkers of PTSD while distinguishing them from general stress-related, potentially adaptive, neurobiological alterations. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Clinical significance of normal exercise thallium-201 myocardial scintigraphy in subjects with abnormal exercise electrocardiographic findings

International Nuclear Information System (INIS)

Matsuo, Takeshi; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Chiba, Hiroshi; Mitani, Isao; Saito, Muneyasu; Sumiyoshi, Tetsuya

1988-01-01

The relationship between exercise thallium-201 scintigraphic findings and clinical features (chest pain, risk factors, resting electrocardiography, exercise electrocardiography and prognosis) was studied in the 234 patients with profound ST-segment depression (J 80 ≥ -2 mm) or negative U wave in exercise electrocardiography. We classified these cases into two groups by exercise thallium perfusion; (I) normal thallium-201 perfusion (n = 24), (II) abnormal thallium-201 perfusion (n = 210). The incidence of female in group I was larger than that in group II. In resting electrocardiography, left ventricular hypertrophy was found more frequent in group I. In exercise electrocardiography, most of ST-segment depression in group I revealed up-slope type and a rapid recovery to baseline. Group I had lower incidence of cardiac events (cardiac death, nonfatal myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting). In conclusion, normal thallium-201 perfusion in exercise thallium-201 scintigraphy was more useful indicator for prognosis, even if the patients had the findings of profound ST-segment depression or negative U wave in exercise electrocardiography. (author)

Abnormal Functional Connectivity Density in Post-traumatic Stress Disorder.

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Zhang, Youxue; Xie, Bing; Chen, Heng; Li, Meiling; Liu, Feng; Chen, Huafu

2016-05-01

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that occurs in individuals who have experienced life-threatening mental traumas. Previous neuroimaging studies have indicated that the pathology of PTSD may be associated with the abnormal functional integration among brain regions. In the current study, we used functional connectivity density (FCD) mapping, a novel voxel-wise data-driven approach based on graph theory, to explore aberrant FC through the resting-state functional magnetic resonance imaging of the PTSD. We calculated both short- and long-range FCD in PTSD patients and healthy controls (HCs). Compared with HCs, PTSD patients showed significantly increased long-range FCD in the left dorsolateral prefrontal cortex (DLPFC), but no abnormal short-range FCD was found in PTSD. Furthermore, seed-based FC analysis of the left DLPFC showed increased connectivity in the left superior parietal lobe and visual cortex of PTSD patients. The results suggested that PTSD patients experienced a disruption of intrinsic long-range functional connections in the fronto-parietal network and visual cortex, which are associated with attention control and visual information processing.

Up-regulation of mRNA ventricular PRNP prion protein gene expression in air pollution highly exposed young urbanites: endoplasmic reticulum stress, glucose regulated protein 78, and nanosized particles.

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Villarreal-Calderon, Rodolfo; Franco-Lira, Maricela; González-Maciel, Angélica; Reynoso-Robles, Rafael; Harritt, Lou; Pérez-Guillé, Beatriz; Ferreira-Azevedo, Lara; Drecktrah, Dan; Zhu, Hongtu; Sun, Qiang; Torres-Jardón, Ricardo; Aragón-Flores, Mariana; Calderón-Garcidueñas, Ana; Diaz, Philippe; Calderón-Garcidueñas, Lilian

2013-11-28

Mexico City Metropolitan Area children and young adults exposed to high concentrations of air pollutants including fine and ultrafine particulate matter (PM) vs. clean air controls, exhibit myocardial inflammation and inflammasome activation with a differential right and left ventricular expression of key inflammatory genes and inflammasomes. We investigated the mRNA expression levels of the prion protein gene PRNP, which plays an important role in the protection against oxidative stress and metal toxicity, and the glucose regulated protein 78, a key protein in endoplasmic reticulum (ER) stress signaling, in ventricular autopsy samples from 30 children and young adults age 19.97 ± 6.8 years with a lifetime of low (n:4) vs. high (n:26) air pollution exposures. Light microscopy and transmission electron microscopy studies were carried out in human ventricles, and electron microscopy studies were also done in 5 young, highly exposed Mexico City dogs. There was significant left ventricular PRNP and bi-ventricular GRP78 mRNA up-regulation in Mexico City young urbanites vs. controls. PRNP up-regulation in the left ventricle was significantly different from the right, p < 0.0001, and there was a strong left ventricular PRNP and GRP78 correlation (p = 0.0005). Marked abnormalities in capillary endothelial cells, numerous nanosized particles in myocardial ER and in abnormal mitochondria characterized the highly exposed ventricles. Early and sustained cardiac ER stress could result in detrimental irreversible consequences in urban children, and while highly complex systems maintain myocardial homeostasis, failure to compensate for chronic myocardial inflammation, oxidative and ER stress, and particles damaging myocardial organelles may prime the development of pathophysiological cardiovascular states in young urbanites. Nanosized PM could play a key cardiac myocyte toxicity role.

Up-Regulation of mRNA Ventricular PRNP Prion Protein Gene Expression in Air Pollution Highly Exposed Young Urbanites: Endoplasmic Reticulum Stress, Glucose Regulated Protein 78, and Nanosized Particles

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Rodolfo Villarreal-Calderon

2013-11-01

Full Text Available Mexico City Metropolitan Area children and young adults exposed to high concentrations of air pollutants including fine and ultrafine particulate matter (PM vs. clean air controls, exhibit myocardial inflammation and inflammasome activation with a differential right and left ventricular expression of key inflammatory genes and inflammasomes. We investigated the mRNA expression levels of the prion protein gene PRNP, which plays an important role in the protection against oxidative stress and metal toxicity, and the glucose regulated protein 78, a key protein in endoplasmic reticulum (ER stress signaling, in ventricular autopsy samples from 30 children and young adults age 19.97 ± 6.8 years with a lifetime of low (n:4 vs. high (n:26 air pollution exposures. Light microscopy and transmission electron microscopy studies were carried out in human ventricles, and electron microscopy studies were also done in 5 young, highly exposed Mexico City dogs. There was significant left ventricular PRNP and bi-ventricular GRP78 mRNA up-regulation in Mexico City young urbanites vs. controls. PRNP up-regulation in the left ventricle was significantly different from the right, p < 0.0001, and there was a strong left ventricular PRNP and GRP78 correlation (p = 0.0005. Marked abnormalities in capillary endothelial cells, numerous nanosized particles in myocardial ER and in abnormal mitochondria characterized the highly exposed ventricles. Early and sustained cardiac ER stress could result in detrimental irreversible consequences in urban children, and while highly complex systems maintain myocardial homeostasis, failure to compensate for chronic myocardial inflammation, oxidative and ER stress, and particles damaging myocardial organelles may prime the development of pathophysiological cardiovascular states in young urbanites. Nanosized PM could play a key cardiac myocyte toxicity role.

Troxerutin abrogates mitochondrial oxidative stress and myocardial apoptosis in mice fed calorie-rich diet.

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Geetha, Rajagopalan; Sathiya Priya, Chandrasekaran; Anuradha, Carani Venkatraman

2017-12-25

Mitochondrial oxidative stress plays a major role in the pathogenesis of myocardial apoptosis in metabolic syndrome (MS) patients. In this study, we investigated the effect of troxerutin (TX), an antioxidant on mitochondrial oxidative stress and apoptotic markers in heart of mice fed fat and fructose-rich diet. Adult male Mus musculus mice were fed either control diet or high fat, high fructose diet (HFFD) for 60 days to induce MS. Mice from each dietary group were divided into two on the 16th day and were either treated or untreated with TX (150 mg/kg bw, p.o) for the next 45 days. At the end of the study, mitochondrial reactive oxygen species (ROS) generation, oxidative stress markers, levels of intracellular calcium, cardiolipin content, cytochrome c release and apoptotic markers were examined in the myocardium. HFFD-feeding resulted in diminution of antioxidants and increased ROS production, lipid peroxidation and oxidatively modified adducts of 8-OHG, 4-HNE and 3-NT. Further increase in Ca 2+ levels, low levels of calcium transporters and decrease in cardiolipin content were noted. Changes in the mitochondrial structure were observed by electron microscopy. Furthermore, cytochrome c release, increase in proapoptotic proteins (APAF-1, BAX, caspases-9 and-3) and decrease in antiapoptotic protein (BCL-2) in HFFD-fed mice suggest myocardial apoptosis. These changes were significantly restored by TX supplementation. TX administration effectively attenuated cardiac apoptosis and exerted a protective role by increasing antioxidant potential and by improving mitochondrial function. Thus, TX could be a promising therapeutic candidate for treating cardiac disease in MS patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Thallium-201 myocardial perfusion scintigraphy to evaluate patients with chest pain (preliminary study)

International Nuclear Information System (INIS)

Mahfouz, M.; Elhaddad, S.; Elghoneimy, I.; Elmesidy, S.; Haggag, F.; Sbdou, S.; Dayem, K.A.; Ezzeldiy, H.

1985-01-01

201 Tl perfusion scintigraphy for the diagnosis of coronary artery disease was carried out in 25 patients of mean age years, presenting with chest pain. Scintiscan were obtained at rest and after exercise and were compared with ECG studies at rest and after exercise. In all patients with previous myocardial infarctions, perfusion defects were present at rest, two of these patients showed abnormal stress scintigraphy consistent with a new ischemic response which was not detected by the stress ECG. In 3 out of the 8 patients with normal ECG, in 2 out of the 4 patients with response suggesting ischemia and in 4 out of the 7 patients with definite ECG proof of ischemia infarction was detected by 201 Tl. In all the previous, resting and exercise ECG failed to show evidence of infarction.1 fig.,2 tab

Myocardial perfusion and left ventricular function early after successful PTCA in 1-vessel coronary artery diseases

International Nuclear Information System (INIS)

Hoffmeister, H.M.; Kaiser, W.; Hanke, H.; Mueller-Schauenburg, W.; Karsch, K.R.; Seipel, L.

1994-01-01

Myocardial perfusion ( 201 Tl-ECT) and contractile function ( 99m Tc-ventriculography) were studied during exercise and rest 3 to 6 days after PTCA in 20 patients (11 with stable and 9 with unstable angina pectoris). All patients had single vessel disease and no previous myocardial infarction. During exercise after PTCA the ejection fraction increased for 3 to 5% and no regional wall motion abnormalities, ST-segment depression or perfusion defects occurred (with exception in one patient with very early restenosis). Therefore, perfusion and wall motion were completely normalized at test and during exercise within days after technically successful PTCA even in patients with previously unstable angina pectoris. Pathological stress test results after this time should thus be attributed to other causes e.g. early restenosis, multivessel disease, false positive tests) and are not due to the specific situation early after PTCA. (orig.) [de

Prediction of functional recovery after primary PCI using the estimate of myocardial salvage in gated SPECT early after acute myocardial infarction

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Calabretta, Raffaella; Castello, Angelo; Linguanti, Flavia; Tutino, Francesca; Ciaccio, Alfonso; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Giglioli, Cristina [Careggi University Hospital, Cardiothoracovascular Department, Florence (Italy)

2018-04-15

Primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) aims to achieve myocardial salvage (MS). Because the reference method for measuring MS requires myocardial perfusion imaging (MPI) after tracer injection before PCI, alternative approaches have been proposed, but none has gained wide acceptance. Gated SPECT MPI can assess infarct size (IS), but can also show myocardial stunning. Thus, we compared functional and perfusion abnormalities early after AMI to estimate MS, and to predict left ventricular ejection fraction (LVEF) recovery at follow-up. We studied 120 patients with AMI. Gated SPECT MPI was performed early (before hospital discharge) and at 6 months after AMI to measure IS, MS and functional outcome. MS was defined as the difference between the number of segments with abnormal thickening (i.e. the stunned area or area at risk) and the number of segments with abnormal perfusion (i.e. the final IS), expressed as a percentage of the total number of segments in the AHA model. LVEF was calculated using quantitative gated SPECT. The area at risk was 40 ± 25%, IS was 17.3 ± 16% and MS was 22 ± 19%. Early LVEF was 46.6 ± 11.6% and late LVEF was 51.4 ± 11.6%, with 54 patients showing at least an increase in LVEF of more than 5 units. ROC analysis showed that MS was able to predict LVEF recovery with an area under the curve (AUC) of 0.79 (p < 0.0001), and using a cut off >23% detected LVEF recovery with 74% sensitivity and 71% specificity. Conversely, IS was associated with an AUC 0.53 (not significant). MS assessed by a single early gated SPECT MPI study can accurately predict LVEF evolution after primary PCI for AMI. (orig.)

Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis

International Nuclear Information System (INIS)

Kahan, A.; Devaux, J.Y.; Amor, B.

1986-01-01

Heart disease in patients with progressive systemic sclerosis may be due in part to myocardial ischemia caused by a disturbance of the coronary microcirculation. To determine whether abnormalities of myocardial perfusion in this disorder are potentially reversible, we evaluated the effect of the coronary vasodilator nifedipine on myocardial perfusion assessed by thallium-201 scanning in 20 patients. Thallium-201 single-photon-emission computerized tomography was performed under control conditions and 90 minutes after 20 mg of oral nifedipine. The mean (+/- SD) number of left ventricular segments with perfusion defects decreased from 5.3 +/- 2.0 to 3.3 +/- 2.2 after nifedipine (P = 0.0003). Perfusion abnormalities were quantified by a perfusion score (0 to 2.0) assigned to each left ventricular segment and by a global perfusion score (0 to 18) for the entire left ventricle. The mean perfusion score in segments with resting defects increased from 0.97 +/- 0.24 to 1.26 +/- 0.44 after nifedipine (P less than 0.00001). The mean global perfusion score increased from 11.2 +/- 1.7 to 12.8 +/- 2.4 after nifedipine (P = 0.003). The global perfusion score increased by at least 2.0 in 10 patients and decreased by at least 2.0 in only 1. These observations reveal short-term improvement in thallium-201 myocardial perfusion with nifedipine in patients with progressive systemic sclerosis. The results are consistent with a potentially reversible abnormality of coronary vasomotion in this disorder, but the long-term therapeutic effects of nifedipine remain to be determined

Regional left ventricular myocardial contraction abnormalities and asynchrony in patients with hypertrophic cardiomyopathy evaluated by magnetic resonance spatial modulation of magnetization myocardial tagging

International Nuclear Information System (INIS)

Mishiro, Yuichiro; Oki, Takashi; Iuchi, Arata

1999-01-01

Global left ventricular (LV) pump function is generally preserved in patients with hypertrophic cardiomyopathy (HCM). However, it is unknown whether regional myocardial contractility is impaired, especially in nonhypertrophied regions. The purpose of this study was to evaluate regional LV myocardial contraction in patients with HCM using magnetic resonance (MR) spatial modulation of magnetization (SPAMM) myocardial tagging. The study group comprised 20 patients with asymmetric septal hypertrophy (HCM group) and 16 age-matched normal patients (control group), and data were collected using transthoracic M-mode and 2-dimensional echocardiography, and MR SPAMM myocardial tagging. The systolic strain ratio, maximum systolic strain velocity, and time from end-diastole to maximum systolic strain (ΔT) in the anterior, ventricular septal, inferior and lateral regions for 2 LV short-axis sections at the levels of the chordae tendineae and papillary muscles were measured at 50-ms intervals by MR myocardial tagging. The end-diastolic anterior and ventricular septal wall thicknesses and LV mass index were significantly different between the HCM and control groups. The systolic strain ratio for all 4 walls, particularly the anterior and ventricular septal regions, was significantly lower in the HCM group. In the HCM group, the maximum systolic strain velocity was significantly lower and ΔT was significantly shorter for all 4 walls, particularly the anterior and ventricular septal regions. The standard deviation for the ΔT, calculated from the ΔT for the 8 regions of the 2 LV short-axis sections, was significantly greater in the HCM group. In conclusion, regional LV myocardial contraction is impaired in both hypertrophied and nonhypertrophied regions, and systolic LV wall asynchrony occurs in patients with HCM. (author)

Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

International Nuclear Information System (INIS)

Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de

2010-01-01

Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

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Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de, E-mail: narezende@terra.com.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Abuhid, Ivana Moura [Instituto de Medicina Nuclear e Diagnostico Molecular, Belo Horizonte, MG (Brazil)

2010-07-15

Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced Ecg-gated multidetector-row computed tomography

International Nuclear Information System (INIS)

Ko, S.M.; Seo, J.B.; Hong, M.K.; Do, K.H.; Lee, S.H.; Lee, J.S.; Song, J.W.; Park, S.J.; Park, S.W.; Lim, T.H.

2006-01-01

Aim: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n=9) or transmural (n=6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n=6); (2) transmural late enhancement (n=1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n=2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction

Clinical study on myocardial imaging with β-methyl-p-(123I)-iodophenyl-pentadecanoic acid in patients with mitochondrial myopathy

International Nuclear Information System (INIS)

Kihara, Koichi; Nakajo, Masayuki; Shono, Hirohisa

1992-01-01

Myocardial imaging with β-methyl-p-( 123 I)-iodophenyl-pentadecanoic acid ( 123 I-BMIPP), a new radiopharmaceutical designed to evaluate myocardial fatty acid metabolism, was performed in 7 patients with mitochondrial myopathy to detect their myocardial damages in comparison with 201 Tl myocardial imaging. These patients were divided into 4 chronic progressive external ophthalmoplegia (CPEO) cases, 2 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) cases and 1 myoclonus epilepsy with ragged-red fibers (MERRF). In visual assessment, we observed more myocardial segments with decreased uptake of 123 I-BMIPP compared to 201 Tl in MELAS cases than in CPEO cases. The mean myocardial uptake of 123 I-BMIPP was higher than that of 201 Tl in CPEO cases. On the other hand, in MELAS and MERRF cases, the mean myocardial uptake of 123 I-BMIPP was lower than that of 201 Tl. Abnormal findings suggesting myocardial damages were observed in echocardiogram and/or in electrocardiogram in MELAS and MERRF cases, while no such abnormal findings were observed in CPEO cases. Along with the previously reported experimental result that the impairment of rat myocardial mitochondria decreased myocardial uptake of 123 I-BMIPP, these results suggest that 123 I-BMIPP may be useful to detect myocardial damages in patients with mitochondrial myopathy. (author)

Correlation of chronic kidney disease, diabetes and peripheral artery disease with cardiovascular events in patients using stress myocardial perfusion imaging

International Nuclear Information System (INIS)

Furuhashi, Tatsuhiko; Masai, Hirofumi; Kunimasa, Taeko; Nakazato, Ryo; Fukuda, Hiroshi; Sugi, Kaoru; Moroi, Masao

2011-01-01

Normal stress myocardial perfusion imaging (MPI) studies generally suggest an excellent prognosis for cardiovascular events. Chronic kidney disease (CKD), diabetes and peripheral artery disease (PAD) have been established as the risk factors for cardiovascular events. However, whether these risk factors significantly predict cardiovascular events in patients with normal stress MPI is unclear. The purpose of this study was to evaluate the prognostic value of these risk factors in patients with normal stress MPI. Patients with normal stress MPI (n=372, male=215 and female=157, age=69 years, CKD without hemodialysis=95, diabetes=99, PAD=19, previous coronary artery disease=116) were followed up for 14 months. Normal stress MPI was defined as a summed stress score of 2 and/or persistent proteinuria. Cardiovascular events included cardiac death, non-fatal myocardial infarction and congestive heart failure requiring hospitalization. Cardiovascular events occurred in 20 of 372 patients (5.4%). In univariate Cox regression analysis, PAD, diabetes, diabetic retinopathy, insulin use, anemia, hypoalbuminemia, CKD, left ventricular ejection fraction and pharmacological stress tests were significant predictors of cardiovascular events. In multivariate Cox regression analysis, PAD, diabetes and CKD were independent and significant predictors for cardiovascular events, and their number was the strongest predictor for cardiovascular events (hazard ratio=21.7, P<0.001). PAD, diabetes and CKD are coexisting, independent and significant risk factors for cardiovascular events, CKD being the strongest predictor. The number of coexisting risk factors is important in predicting cardiovascular events in patients with normal stress MPI. (author)

Emission computed tomography using rotating gamma cameras for stress 201Tl myocardial imaging

International Nuclear Information System (INIS)

Takeda, Kan; Maeda, Hisato; Nakagawa, Tsuyoshi; Yamaguchi, Nobuo; Taguchi, Mitsuo

1983-01-01

The purpose of this study is to evaluate the efficacy of emission computed tomography (ECT) for stress 201 Tl myocardial imaging to localize coronary artery disease (CAD) in comparison with planar (PL) images. In a series of 14 normal subjects and 53 patients with CAD proved coronary arteriography, ECT and PL imaging were performed successively. ECT data were collected for 90 projections in a 64 x 64 matrix form with a total aquisition time of 6 munutes over 180 0 of opposed dual cameras ratation and tomographic sections oriented perpendicular and parallel to the long axis of left ventricle were reconstructed. PL images were obtained for left lateral, left anterior oblique (30 0 and 45 0 ) and anterior projections. Both ECT and PL myocardial images were divided into 8 segments and segmental analysis was performed by visual interpretation. The ECT images remarkably increased sensitivity over the PL images in left anterior descending (LAD) artery (from 56% to 76%), right coronary artery (RCA) (from 50% to 96%), and circumflex artery (CX) (from 56% to 69%) lesions. The specificity for ECT images, as compared with PL images, was higher in LAD (88% against 85%) but slightly lower in RCA (70% ag ainst 72%) and CX (84% against 88%). Overall accuracy, therefore, was improved in LAD (from 67% to 81%) and RCA (from 64% to 79%) but equal in CX (81%). We conclude that stress 201 Tl ECT imaging result in a remarkable improvement in the localization of CAD, especially in patients with RCA lesions and multi-vessel disease. (author)

Usefulness of isoproterenol stress thallium-201 myocardial single photon emission computed tomography (SPECT)

International Nuclear Information System (INIS)

Watanabe, Shigeyuki; Ajisaka, Ryuichi; Masuoka, Takeshi

1990-01-01

Twenty patients complaining of chest pain were referred for isoproterenol stress thallium-201 myocardial single photon emission computed tomography (ISO-SPECT). The findings were compared with those obtained from isoproterenol stress ECG testing (ISO-ECG) and exercise SPECT (EX-SPECT). Isoproterenol was iv injected in a dose of 0.02 μg/kg/min. The amount was continuously increased until limited by chest pain, ST depression, and/or determined heart rate criteria. The patients were scanned immediately and three hours after giving isoproterenol. Transient hypoperfusion was regarded as myocardial ischemia. Washout rate, obtained from circumferential profile analysis on the short axis SPECT images, was expressed by Bull's eye display. Fifteen patients with angiographically significant stenosis of 75% or greater were diagnosed as having coronary artery disease (CAD). The other five patients had normal coronary artery (NC). In diagnosing CAD, ISO-ECG and ISO-SPECT had a sensitivity of 80% and 92%, respectively. Because the NC group had negative findings for redistribution on ISO-SPECT, the specificy of ISO-SPECT seemed to be high. For multi-vessel disease, redistribution on ISO-SPECT tended to underestimate coronary lesions. The underestimation was, however, corrected by calculating washout rate. For evaluable 11 patients undergoing concurrent EX-SPECT, ISP-SPECT was equivalent or superior to EX-SPECT in diagnostic sensitivity. None of the patients had severe side effects of isoproterenol, except for some having arrhythmia. The results indicated that ISO-SPECT is a safe, high sensitive diagnostic approach that is comparable to Ex-SPECT. (N.K.)

NOGA-guided analysis of regional myocardial perfusion abnormalities treated with intramyocardial injections of plasmid encoding vascular endothelial growth factor A-165 in patients with chronic myocardial ischemia: subanalysis of the EUROINJECT-ONE multicenter double-blind randomized study

DEFF Research Database (Denmark)

Gyongyosi, Mariann; Khorsand, Aliasghar; Zamini, Sholeh

2005-01-01

. The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI....... CONCLUSIONS: Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A165 plasmid improve, but do not normalize, the stress...

Evaluation of the specificity of radionuclide myocardial imaging for detecting CAD

International Nuclear Information System (INIS)

Liu Xiujie

1992-01-01

In order to evaluate the specificity of radionuclide myocardial perfusion imaging for detecting coronary artery disease (CAD), 50 patients with normal coronary arteriography and radionuclide myocardial perfusion scintigraphy were analysed. The results from 201 T1 (20 cases) and 99m Tc-MIBI (30 cases) studies showed that out of 33 patients with no organic cardiovascular disease, 29 had normal myocardial imaging, and the specificity of radionuclide myocardial imaging for detecting CAD was 87.8%. 4 normal young women had false positive myocardial imaging. Out of 17 patients with cardiovascular disease and normal coronary arteriography, 15 patients had abnormal myocardial imaging. The final clinical diagnoses of these 15 patients were: 4 patients with hypertrophic cardiomyopathy, 3 with old myocardial infarction, 2 with myocarditis, 3 with small coronary vessel disease, 1 with congestive cardiomyopathy, and 2 with other cardiac disorder. The points of differentiation between CAD and other cardiovascular disease using radionuclide techniques were discussed

Dobutamine cine magnetic resonance imaging after myocardial infarction

International Nuclear Information System (INIS)

Giovagnoni, A.; Ligabue, G.; Romagnoli, R.; Reggio Emilia Univ., Reggio Emilia; Rossi, R.; Muia, N.; Modena, M.G.; Reggio Emilia Univ.

1999-01-01

Dobutamine Cine MRI is a new diagnostic imaging technique in the pretreatment (revascularization) assessment of myocardial infarction patients. In this issue are reported the result of a comparative study of the diagnostic yield of dobutamine Cine MRI with that of stress echocardiography in the assessment of viable myocardium. A new method for analysis of Cine MR images, employing digital subtraction, aimed at decreasing subjectivity in the quantitative assessment of myocardial wall thickening. Twenty-six patients (21 men and 5 women) with a history of myocardial infarction who were scheduled for revascularization were submitted to stress echocardiography and dobutamine Cine MRI to evaluate contractile recovery of the segments considered akinetic or hypo kinetic at baseline echocardiography. Dobutamine was administered in growing doses (5, 10, 15γ/kg/min). 16 segments of the left ventricle in each patient were considered. In the 416 segments studied, it was found that 307 normo kinetic, 64 scarred and 45 viable segments with stress echocardiography, versus 302 normo kinetic, 83 scarred and 31 viable segments with dobutamine MRI. Three months after revascularization 15 patients were examined to check contractile recovery of the segments considered as viable. Echocardiography had 79% sensitivity and 97% specificity, while Cine MRI had 96% and 86%, respectively. In patients with anteroseptal wall myocardial infarction stress echocardiography had 75% sensitivity and 97% specificity. Echocardiography permits to distinguish viable myocardium and scarred myocardial tissue with good sensitivity and specificity, but Cine MRI performs better. Cine MRI has much higher sensitivity than stress echocardiography and thus makes the technique of choice to evaluate viable myocardium in these sites. The digital subtraction technique is as accurate as manual measurements, but reduces the error rate and permits quicker evaluation, particularly in subendocardial thickening [it

Quantification of the right ventricular wall using stress myocardial emission computed tomography with thallium-201 in normal subjects

International Nuclear Information System (INIS)

Akanabe, Hiroshi; Oshima, Motoo; Sakuma, Sadayuki; Yamamoto, Shuhei; Kawai, Naoki; Sotobata, Iwao

1985-01-01

Although many studies of quantitative analysis of left ventricular myocardial wall (LVMW) have been reported using stress thallium-201 (Tl-201), few reports of right ventricular myocardial wall (RVMW) have been estimated. In this study we determined whether single photon emission computed tomography (SPECT) with Tl-201 could accurately define normal range of RVMW in normal subjects. Twelve persons who have no valvular disease, nor coronary artery disease were included in this study. Stress SPECT study was reconstructed to make a short axial images of ventricles. RVMW and LVMW were flagged by mamual. Each ventricle was divided into 36 parts at every 10 degree. Relative activity counts in each ventricle were calculated as a percent counts of maximum counts in left ventricle. The normal range of RVMW with stress SPECT was as follows: anterior wall (33.2 +- 11.4 %, mean +- 2 standard deviation, -62.7 +- 18.4 %), free wall (30.1 +- 12.4 % - 38.5 +- 8.8 %), inferior wall (40.4 +- 7.8 % - 60.0 +- 21.4 %), septal wall (65.2 +- 17.2 % - 71.1 +- 14.2 %). Above the results, SPECT with Tl-201 can accurately define the normal range of RVMW, and this method is usefull to quantify the degree of ischemia and hypertrophy in RVMW. (author)

Fundamental and clinical evaluation of Fourier analysis for the detection of regional wall contraction abnormalities in the patients with myocardial infarction

International Nuclear Information System (INIS)

Murata, H.; Toyama, H.; Tabuchi, H.; Muraki, T.; Ohtake, E.; Chiba, K.; Yamada, H.

1982-01-01

The purpose of the present study are to evaluate fundamentally the method of Fourier analysis and to detect regional wall motion abnormality of the infarcted lesions by Fourier analysis. Fourier analyses were performed using the data obtained by first pass method in right anterior oblique projection (RAO) and by equilibrium method in left anterior oblique projection (LAO), and amplitude and phase were calculated. Amplitude and phase values needed to be corrected by R-R interval. On the detection of myocardial infarction, Fourier analyses in RAO and in LAO had same value for anterior infarctions. The analysis in RAO was more sensitive to detect infero-posterior lesions. On the other hand, the analysis in LAO was more sensitive for septal and lateral lesions

Clinical usefulness of 123I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) myocardial SPECT in coronary artery disease

International Nuclear Information System (INIS)

Ito, Kazuki

1998-01-01

123 I-BMIPP (BMIPP) myocardial SPECT was carried out in 22 patients with acute myocardial infarction, in 20 patients with unstable angina pectoris, in 80 patients with effort angina pectoris and in 25 patients with vasospastic angina pectoris. In a study of patients with acute myocardial infarction, BMIPP uptake was less than thallium perfusion in areas of myocardial infarction. Such discordant BMIPP/thallium uptake was often observed in areas with recanalized arteries, and in those with abnormal wall motion. In the areas showing discordant BMIPP/thallium uptake, the wall motion abnormalities improved in the chronic phase after recanalization therapy. Therefore, the discordant BMIPP/thallium uptake might represent asynergic but viable regions, and might be valuable in predicting the improvement of wall motion abnormalities. In a study of patients with unstable angina pectoris, the severity of regional wall motion abnormality was significantly correlated with severity of BMIPP uptake. BMIPP imaging well visualized the culprit regions in patients with unstable angina pectoris. In a study of patients with effort angina pectoris, the abnormal BMIPP images were associated with severe coronary artery stenosis of more than 90% and with multivessel stenosis. BMIPP imaging could detect patients with functionally severe coronary artery disease and help to guide coronary angioplasty in patients with effort angina. In a study of patients with vasospastic angina pectoris, metabolic abnormality assessed by BMIPP was associated with left ventricular asynergy and spastic regions. Those abnormalities also correlated inversely with the period from the last attack, and improved after medical treatment. (K.H.)

Impact on adenosine stress cardiac magnetic resonance for recanalisation and follow up of chronic total coronary occlusions

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Heyne, J.P. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Jens-Peter.Heyne@med.uni-jena.de; Goernig, M. [Clinic for Internal Medicine I, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Matthias.Goernig@med.uni-jena.de; Feger, J. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Joachim.Feger@email.de; Kurrat, C. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Claudia.Kurrat@med.uni-jena.de; Werner, G.S. [Clinic for Internal Medicine I, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Gerald.Werner@Klinikum-Darmstadt.de; Figulla, H.R. [Clinic for Internal Medicine I, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Hans.Figulla@med.uni-jena.de; Kaiser, W.A. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Werner.Kaiser@med.uni-jena.de

2007-09-15

Objective: To evaluate the impact on cardiac magnetic resonance imaging (CMRI) with adenosine stress and delayed enhancement for indication and follow up after interventional recanalisation of chronic total coronary occlusions (CTOs). Material and methods: Twenty consecutive patients (15 males; 5 females; mean age 65 years) with CTO verified by cardiac catheterisation referred to CMRI. Sixteen of them got CMRI before and after coronary recanalisation. Wall motion abnormalities (WMAs), first pass perfusion with adenosine and viability were assessed using a 1.5 T MR scanner (Sonata; Siemens). CMRI results were compared with clinical classifications, the results of cardiac catheterisation and follow up angiography. Results: Sixteen patients had a successful recanalisation, 15 of the occluded coronary artery and one of collateral donor artery stenosis. After recanalisation all stress-induced progressive or new wall motion abnormalities (WMAs) of the corresponding segments and in the collateral donor territory (5 patients) and all adenosine induced perfusion defects (PD) or delay (12 patients) were regredient. 13/16 patients showed no transmural and one patient transmural delayed enhancement (DE) indicating myocardial scar. In 10/16 patients CSS grading of angina improved after recanalisation. Conclusion: After successful recanalisation of CTOs, patients with preinterventional stress-induced PDs and WMAs in viable myocardium did not display any signs of stress-induced ischemia postinterventionally. A comprehensive CMRI approach, including assessment of rest and stress WMAs, first pass perfusion and myocardial viability represents an important tool for the pre-interventional decision to recanalise CTOs and follow up.

Detection of exercise induced ischemia in the asymptomatic recent post myocardial infarction patient: comparison of stress electrocardiography and radionuclide angiography

International Nuclear Information System (INIS)

Jengo, J.A.; Brizendine, M.; Dykstra, L.; Sweet, J.; Bruno, M.; Garcia, A.

1982-01-01

The purpose of this study was to compare the techniques of low level stress electrocardiography and radionuclide angiographic wall motion analysis for the detection of new areas of myocardial ischemia in the asymptomatic recent post-myocardial infarction patient. The protocol consisted of obtaining a resting, RAO upright first pass radionuclide angiocardiogram using 15 mCi of 99m technetium-DTPA. The study suggests that assessment of segmental wall motion during low level stress can detect areas of myocardium at high risk either intermixed with or in addition to recently infarcted areas in the asymptomatic post-infarction patient, which are not detected by ECG. This high risk subset of patients can then be observed or treated in a more vigorous manner. This technique allows for not only the identification of additional areas of myocardium at jeopardy but also provides information regarding the severity of ischemic dysfunction, an important prognostic and therapeutic factor

Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion.

Science.gov (United States)

Burg, Matthew M; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W; Schwartz, Joseph E; Soufer, Robert

2014-10-30

Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Patients (N=146) completed the Beck Depression Inventory-I (BDI-I), a measure of depression linked to recurrent ACS and post-ACS mortality, and underwent single-photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI-I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI-I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression-associated risk for ACS recurrence and mortality. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Initial multicentre experience of high-speed myocardial perfusion imaging: comparison between high-speed and conventional single-photon emission computed tomography with angiographic validation

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Neill, Johanne [University College London Hospital, Institute of Nuclear Medicine, London (United Kingdom); The Prince Charles Hospital, Brisbane (Australia); Prvulovich, Elizabeth M.; Bomanji, Jamshed B. [University College London Hospital, Institute of Nuclear Medicine, London (United Kingdom); Fish, Matthews B. [Sacred Heart Medical Center (SHMC), Springfield, OR (United States); Berman, Daniel S.; Slomka, Piotr J. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Sharir, Tali [Procardia Maccabi Healthcare Services (PMHS), Tel Aviv (Israel); Martin, William H. [Vanderbilt University Medical Center (VUMC), Nashville, TN (United States); DiCarli, Marcelo F. [Brigham and Women' s Hospital (BWH), Boston, MA (United States); Ziffer, Jack A. [Baptist Hospital of Miami (BHM), Miami, FL (United States); Shiti, Dalia [Spectrum-Dynamics, Caesarea (Israel); Ben-Haim, Simona [University College London Hospital, Institute of Nuclear Medicine, London (United Kingdom); Chaim Sheba Medical Center, Department of Nuclear Medicine, Tel-Hashomer (Israel)

2013-07-15

High-speed (HS) single-photon emission computed tomography (SPECT) with a recently developed solid-state camera shows comparable myocardial perfusion abnormalities to those seen in conventional SPECT. We aimed to compare HS and conventional SPECT images from multiple centres with coronary angiographic findings. The study included 50 patients who had sequential conventional SPECT and HS SPECT myocardial perfusion studies and coronary angiography within 3 months. Stress and rest perfusion images were visually analysed and scored semiquantitatively using a 17-segment model by two experienced blinded readers. Global and coronary territorial summed stress scores (SSS) and summed rest scores (SRS) were calculated. Global SSS {>=}3 or coronary territorial SSS {>=}2 was considered abnormal. In addition the total perfusion deficit (TPD) was automatically derived. TPD >5 % and coronary territorial TPD {>=}3 % were defined as abnormal. Coronary angiograms were analysed for site and severity of coronary stenosis; {>=}50 % was considered significant. Of the 50 patients, 13 (26 %) had no stenosis, 22 (44 %) had single-vessel disease, 6 (12 %) had double-vessel disease and 9 (18 %) had triple-vessel disease. There was a good linear correlation between the visual global SSS and SRS (Spearman's {rho} 0.897 and 0.866, respectively; p < 0.001). In relation to coronary angiography, the sensitivities, specificities and accuracies of HS SPECT and conventional SPECT by visual assessment were 92 % (35/38), 83 % (10/12) and 90 % (45/50) vs. 84 % (32/38), 50 % (6/12) and 76 % (38/50), respectively (p < 0.001). The sensitivities, specificities and accuracies of HS SPECT and conventional SPECT in relation to automated TPD assessment were 89 % (31/35), 57 % (8/14) and 80 % (39/49) vs. 86 % (31/36), 77 % (10/13) and 84 % (41/49), respectively. HS SPECT allows fast acquisition of myocardial perfusion images that correlate well with angiographic findings with overall accuracy by visual

Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease

Directory of Open Access Journals (Sweden)

Sarah Ghonim

2017-05-01

Full Text Available Congenital heart disease (CHD is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.

Noninvasive detection of regional myocardial ischemia using rubidium-81 and scintillation camera. Comparison with stress electrocardiography in patients with arteriographically documented coronary stenosis

International Nuclear Information System (INIS)

Berman, D.S.; Salel, A.F.; DeNardo, G.L.; Mason, D.T.

1975-01-01

The sensitivity of rest and stress myocardial perfusion studies using scintillation camera imaging of intravenously administered rubidium-81 ( 81 Rb) in the detection of myocardial ischemia was compared to that of stress electrocardiography by relating results in 40 patients to the degree of stenosis delineated by coronary arteriography. Of 33 patients with greater than 75 percent stenosis of at least one of the three major coronary vessels (significant stenosis), rest and stress 81 Rb imaging detected ventricular ischemia in 29 (88 percent), whereas simultaneous stress electrocardiography was positive (1 mm or greater horizontal ST-segment depression) in only 19 (58 percent) of the same patients. Five of the 29 patients who developed stress-induced scintigraphic evidence of ischemia did not develop angina or a positive electrocardiogram with stress. In 31 of the 33 patients with significant coronary stenosis, either the stress scintigram or the stress electrocardiogram was positive. In seven patients with less than 50 percent narrowing of a major coronary vessel on coronary arteriography, the stress scintigrams were negative, whereas the stress electrocardiograms were positive in the two of these patients with the syndrome of angina with normal coronary arteriograms. It is concluded that high resolution images of the myocardium can be obtained with 81 Rb using the scintillation camera with special shielding, and that rest and stress 81 Rb scintigraphy appears to provide greater sensitivity and specificity when compared to stress electrocardiography in the noninvasive identification of significant coronary stenosis

Machine learning improves the accuracy of myocardial perfusion scintigraphy results

International Nuclear Information System (INIS)

Groselj, C.; Kukar, M.

2002-01-01

Objective: Machine learning (ML) an artificial intelligence method has in last decade proved to be an useful tool in many fields of decision making, also in some fields of medicine. By reports, its decision accuracy usually exceeds the human one. Aim: To assess applicability of ML in interpretation of the stress myocardial perfusion scintigraphy results in coronary artery disease diagnostic process. Patients and methods: The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy of the investigation were computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate with whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy of scintigraphy were expressed in this way. The results of both decision procedures were compared. Conclusion: Using ML method, 19 more patients out of 327 (5.8%) were correctly diagnosed by stress myocardial perfusion scintigraphy. In this way ML could be an important tool for myocardial perfusion scintigraphy decision making

Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study

International Nuclear Information System (INIS)

Nishimura, Tsunehiko; Nakajima, Kenichi; Kusuoka, Hideo; Yamashina, Akira; Nishimura, Shigeyuki

2008-01-01

Although the prognostic value of myocardial perfusion imaging using gated single photon emission computed tomography (SPECT) for predicting major cardiac events has been evaluated, little is known about the relevance of this procedure to the Japanese population. A total of 4,031 consecutive Japanese patients with suspected or confirmed ischemic heart diseases were registered at 117 hospitals in the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT investigation. Gated stress/rest myocardial perfusion SPECT was performed and the patients were followed up for 3 years. Segmental perfusion scores and quantitative gated SPECT results were calculated. Major cardiac events were defined as cardiac death, nonfatal myocardial infarction, and severe heart failure. During the 3-year follow-up, cardiac death (n = 57) and nonfatal myocardial infarction (n = 39) occurred in 96 patients (2.4%/3 years) when hard events were the endpoints. When severe heart failure was included as an endpoint, major cardiac events that developed in 175 patients (4.3%/3 years) comprised cardiac death (n = 45), nonfatal myocardial infarction (n = 37), and severe heart failure (n = 93). Normal and severely abnormal summed stress score values were associated with low (2.31%/3 years) and high (9.21%/3 years) rates of major cardiac events, respectively. Rates of major cardiac events were significantly higher in patients with ejection fraction (EF) <45% than in those with EF 45% or higher (16.55 vs 2.94%/3 years; P < 0.001). The incidence of major cardiac events within 3 years was also significantly higher among patients with high end-systolic volumes. The major event rates were similar among nondiabetic patients with and diabetic patients without prior myocardial infarction at 5.06% and 5.73%/3 years, respectively. Cardiac event rates were significantly lower in the Japanese than in the USA and European populations. However, large myocardial perfusion defects and

Detection of myocardial metabolic abnormalities by 18F-FDG PET/CT and corresponding pathological changes in beagles with local heart irradiation

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Yan, Rul [Nursing College of Shanxi Medical University, Taiyuan (China); Song, Jianbo; Wu, Zhi Fang; Liu, Jian Zhang; Hao, Xin Zhong; Li, Sijin [Dept. of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan (China); Guo, Min [Dept. of Cardiology, First Hospital of Shanxi Medical University, Taiyuan (China); Li, Jianguo [Dept. of Radiological and Environmental Medicine, China Institute for Radiation Protection, Taiyuan (China)

2015-08-15

To determine the efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the detection of radiation-induced myocardial damage in beagles by comparing two pre-scan preparation protocols as well as to determine the correlation between abnormal myocardial FDG uptake and pathological findings. The anterior myocardium of 12 beagles received radiotherapy locally with a single X-ray dose of 20 Gy. 18F-FDG cardiac PET/CT was performed at baseline and 3 months after radiation. Twelve beagles underwent two protocols before PET/CT: 12 hours of fasting (12H-F), 12H-F followed by a high-fat diet (F-HFD). Regions of interest were drawn on the irradiation and the non-irradiation fields to obtain their maximal standardized uptake values (SUVmax). Then the ratio of the SUV of the irradiation to the non-irradiation fields (INR) was computed. Histopathological changes were identified by light and electron microscopy. Using the 12H-F protocol, the average INRs were 1.18 ± 0.10 and 1.41 ± 0.18 before and after irradiation, respectively (p = 0.021). Using the F-HFD protocol, the average INRs were 0.99 ± 0.15 and 2.54 ± 0.43, respectively (p < 0.001). High FDG uptake in irradiation field was detected in 33.3% (4/12) of 12H-F protocol and 83.3% (10/12) of F-HFD protocol in visual analysis, respectively (p = 0.031). The pathology of the irradiated myocardium showed obvious perivascular fibrosis and changes in mitochondrial vacuoles. High FDG uptake in an irradiated field may be related with radiation-induced myocardial damage resulting from microvascular damage and mitochondrial injury. An F-HFD preparation protocol used before obtaining PET/CT can improve the sensitivity of the detection of cardiotoxicity associated with radiotherapy.

Diagnostic value of rest and stress gated 82Rb PET myocardial perfusion imaging using quantitative software

International Nuclear Information System (INIS)

Shi Hongcheng; Gu Yusen; Liu Wenguan; Zhu Weimin; Halkar, R.K.; Santana, C.A.; Feng Yusheng

2008-01-01

Objective: Gated myocardial perfusion imaging (MPI) is regularly performed using SPECT. More recently, gated 82 Rb MPI has been used to assess left ventricular myocardial perfusion and function with new generation PET scanners. The objective of this study was to evaluate the value of rest and stress gated 82 Rb PET myocardial perfusion imaging and to determine whether the quantitative technique in- creased the confidence level of the interpreters. Methods: Thirty-two patients underwent rest and adenosine stress gated 82 Pb PET MPI. Emory Cardiac Toolbox quantitative software was used for processing and inter-predation. Left ventricular ejection fraction (LVEF), end-diastolic, end-systolic and transient ischemia dilation ratio were automatically generated. Three interpreters (nuclear medicine doctors) independently reviewed the studies. Visual scoring (1-5 scales: excellent, good, unsure, poor, uninterpretable) was used to assess the overall quality of the gated images and the added confidence level of interpretation. Visual assessment of the LVEF was compared to the automatically generated LVEF. Comparison between the visual assessment and software generated was graded on a 1- 5 scales (helpful, probably helpful, unsure, probably not helpful, definitely not helpful). The analysed items were divided into two groups (favorable group and negative group). The percentage and 95% confidence intervals of each group were calculated. Results: A total of 192 gated studies were evaluated (64 gated x 3 interpreters ). The overall quality of the gated images was good [excellent 40.1% (77/192), good 43.2% (83/192), unsure 3.1% (6/192), poor 13.6% (26/192), uninterpretable 0]. The 95% confidence intervals of good and excellent quality range from 78.1% to 88.6%. The interpreter's agreed with the automated LVEF on 85.4% of the gated images [agree 76.6% (147/192), probably agree 8.8% (17/192), unsure 3.1% (6/192), probably disagree 8.8% (17/192), disagree 2.6% (5/192)]. And its 95

Myocardial scintigraphy: methods and indications

International Nuclear Information System (INIS)

Knapp, W.H.

1993-01-01

Myocardial scintigraphy comprises perfusion imaging using TI-201 or - more recently - Tc-99m-labeled compounds with high affinity to myocytes. Imaging with these agents has become an important procedure in the detection of coronary artery disease, particularly in patients with non-diagnostic stress-ECG, in the functional evaluation of coronary stenoses after angiographical documentation in order to meet the adequate therapy decision, in therapy monitoring and follow-up, in the post infarction assessment of myocardial viability and differentiation between severe ischemia and scar and, occasionally, in acute ischemia. The use of positron emitters does not offer significant advantages for mere perfusion imaging, but is indispensable for the scintigraphic investigation of certain aspects of myocardial metabolism, particularly for the differentiation of viable ischemic wall segments from irreversibly damaged tissue. Imaging of myocardial necrosis has been improved by the introduction of labeled antimyosin antibody fragments and offers a considerable clinical potential in the diagnosis of myocarditis and cardiac transplant rejection. Neurohumoral aspects are increasingly involved in our understanding of myocardial failure. Scintigraphy of innervation/neurotransmission contributes to the investigation of pathophysiological alterations in myocardial insufficiency and in heart transplants. (orig.) [de

Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

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Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

2015-07-15

To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

Sepsis-induced myocardial dysfunction and myocardial protection from ischemia/reperfusion injury.

Science.gov (United States)

McDonough, Kathleen H; Virag, Jitka Ismail

2006-01-01

Sepsis, bacteremia and inflammation cause myocardial depression. The mechanism of the dysfunction is not clearly established partly because dysfunction can be elicited by many different mechanisms which can all manifest in disruption of myocardial mechanical function. In addition the models of sepsis and bacteremia and inflammation may vary drastically in the sequence of the coordinated immune response to the inflammatory or septic stimulus. Patterns of cytokine expression can vary as can other responses of the immune system. Patterns of neurohumoral activation in response to the stress of sepsis or bacteremia or inflammation can also vary in both magnitude of response and temporal sequence of response. Stress induced activation of the sympathetic nervous system and humoral responses to stress have a wide range of intensity that can be elicited. The fairly uniform response of the myocardium indicating cardiac dysfunction is surprisingly constant. Systolic performance, as measured by stroke volume or cardiac output and pressure work as estimated by ventricular pressure, are impaired when myocardial contraction is compromised. At times, diastolic function, assessed by ventricular relaxation and filling, is impaired. In addition to the dysfunction that occurs, there is a longer term response of the myocardium to sepsis, and this response is similar to that which is elicited in the heart by multiple brief ischemia/reperfusion episodes and by numerous pharmacological agents as well as heat stress and modified forms of lipopolysaccharide. The myocardium develops protection after an initial stress such that during a second stress, the myocardium does not exhibit as much damage as does a non-protected heart. Many agents can induce this protection which has been termed preconditioning. Both early preconditioning (protection that is measurable min to hours after the initial stimulus) and late preconditioning (protection that is measurable hours to days after the initial

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

Energy Technology Data Exchange (ETDEWEB)

Nakajima, Kenichi [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Yamasaki, Yoshimitsu [Osaka University, Center for Advanced Science and Innovation, Osaka (Japan); Kusuoka, Hideo [National Hospital Organization Osaka National Hospital, Osaka (Japan); Izumi, Tohru [Kitasato University, Department of Cardiology and Internal Medicine, Sagamihara (Japan); Kashiwagi, Atsunori [Shiga University of Medical Science, Department of Medicine, Ohtsu (Japan); Kawamori, Ryuzo [Juntendo University, Department of Medicine, Metabolism and Endocrinology, School of Medicine, Tokyo (Japan); Shimamoto, Kazuaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine, Sapporo (Japan); Yamada, Nobuhiro [University of Tsukuba, Division of Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Medicine, Tsukuba (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, 465 Kajii-cho, Kawara-machi, Hirokoji, Kamigyo-ku, Kyoto (Japan)

2009-12-15

Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. A total of 506 asymptomatic patients {>=}50 years of age who had carotid artery maximum intima-media thickness {>=}1.1 mm, urinary albumin excretion of {>=}30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13, and {>=}14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients. (orig.)

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

International Nuclear Information System (INIS)

Nakajima, Kenichi; Yamasaki, Yoshimitsu; Kusuoka, Hideo; Izumi, Tohru; Kashiwagi, Atsunori; Kawamori, Ryuzo; Shimamoto, Kazuaki; Yamada, Nobuhiro; Nishimura, Tsunehiko

2009-01-01

Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients. (orig.)

Effect of eating on thallium-201 myocardial redistribution after myocardial ischemia

International Nuclear Information System (INIS)

Angello, D.A.; Wilson, R.A.; Palac, R.T.

1987-01-01

To determine whether eating a high-carbohydrate meal between initial and delayed postexercise thallium-201 (Tl-201) imaging affects detection of Tl-201 redistribution during exercise stress testing, 16 patients with stable angina performed 2 Tl-201 treadmill exercise stress tests within a 14-day interval. Immediately after initial postexercise imaging, patients either drank a commercially available instant breakfast preparation for the intervention test or drank an equivalent volume of water for the control test. Comparable exercise workloads were achieved by exercising patients to the same heart rate for both tests. The order of the 2 (intervention and control) tests were randomized. All patients had at least 1 region of Tl-201 myocardial redistribution on either their eating or control test scans, although only 7 of the 16 had positive treadmill exercise test responses. Forty-six regions showing Tl-201 myocardial redistribution were identified in all 144 regions examined. Significantly more of these regions were identified on control test scans than on eating test scans: 11 of 46 on both test scans, 6 of 46 only on eating test scans and 29 of 46 only on control scans (p less than 0.001). Consistent with results of the quantitative regional analysis, the percentage of Tl-201 clearance over 4 hours in the 46 Tl-201 myocardial redistribution regions was 39 +/- 8% for the eating tests and 29 +/- 8% for control tests (mean +/- standard deviation, p less than 0.003). In 4 patients diagnosis of transient ischemia would have been missed because their 14 Tl-201 myocardial redistribution regions were detected only on the control test scans

Physiologic stress interventions in cardiac imaging

International Nuclear Information System (INIS)

Buda, A.J.

1985-01-01

Physiologic stress interventions are designed to assess the reserve capability of coronary flow and myocardial function. In the normal individual, a sufficiently intense physiologic stress may increase coronary flow and cardiac output by 500% to 600%. However, in patients with cardiac disease, these reserve responses may be absent, or considerably blunted. Thus, physiologic stress testing has proved extremely helpful in detecting cardiac abnormalities when resting cardiac function appears normal. Although dynamic exercise remains the standard approach to physiologic stress testing, a number of other interventions have been used, including: (1) isometric exercise, (2) atrial pacing, (3) cold pressor testing, (4) postextrasystolic potentiation, (5) volume loading, and (6) negative intrathoracic pressure. Each of these may be considered an alternative physiologic intervention whenever dynamic exercise is not feasible. These alternative approaches are important since, in our experience, 20% to 30% of subjects are unable to perform dynamic exercise, or exercise inadequately to produce a sufficiently intense cardiac stress. This chapter reviews physiologic considerations, indications, contraindications, protocols, and results of these physiologic stress interventions when used in combination with cardiac radionuclide procedures

Assessment of the myocardial perfusion pattern in patients with multivessel coronary artery disease

International Nuclear Information System (INIS)

Iskandrian, A.S.; Hakki, A.H.; Segal, B.L.; Kane, S.A.; Amenta, A.

1983-01-01

A total of 42 symptomatic patients with coronary artery disease involving two or three vessels were studied using exercise thallium-201 myocardial scintigraphy. Qualitative analysis of the images predicted multivessel disease in 75% of the patients with two-vessel disease and in 82% of the patients with three-vessel disease. Quantitative analysis of the size of the perfusion defect indicated that approximately 40% of the left ventricular perimeter showed abnormal perfusion pattern during stress in these patients, and there was no significant difference in the size of the defect in patients with two-vessel disease or three-vessel disease (41 +/- 17% vs 42 +/- 14%, respectively, mean +/- SD). The exercise heart rate, exercise ECG response, and severity of narrowing did not correlate with the size of the perfusion defect. Patients with anterior infarction had larger defects in the distribution of the left anterior descending artery than those without infarction. Collaterals offered partial protection during exercise only when they were not jeopardized. This study confirms the value of qualitative analysis of exercise thallium-201 imaging in predicting multivessel disease, and describes a simple method of assessing the extent of perfusion abnormalities during stress in patients with multivessel disease. The results may be important in patient management and prognosis

Hemodynamic stress testing using pacing tachycardia

International Nuclear Information System (INIS)

McKay, R.G.; Grossman, W.

1986-01-01

A trial pacing was first introduced in 1967 by Sowton and co-workers as a stress test which could be used in the cardiac catheterization laboratory to evaluate patients with schemic heart disease. Sowton noted that artificially increasing the heart rate by pacing the right atrium could usually induce angina in patients with symptomatic coronary artery disease. Since Sowton's original description, numerous investigators have described characteristic pacing-induced electrocardiographic changes, derangements of myocardial lactate metabolism, hemodynamic abnormalities, regional wall abnormalities, and defects in thallium scintigraphy. Although agreement on the overall usefulness of atrial pacing has not been uniform, it is clear that the technique can safely and reliably induce ischemia in most patients with coronary artery disease and that information obtained during the pacing-induced ischemic state can often be helpful in the diagnosis and treatment of the patient's underlying disease

The usefulness of planar thallium myocardial perfusion imaging in the diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Johannesen, K.A.; Andersen, K.; Foelling, M.; Vik-Mo, H.

1991-01-01

Stress thallium scintigraphy was performed in 60 patients with chest pain of uncertain origin. Myocardial ischemia was identified in 91% og the 47 patients who had angiographically significant coronary artery stenosis. Sensitivity of thallium scintigraphy was highest in patients with stenosis in the left descending coronary artery (LAD); 91% of the patients had abnormal thallium as compared with 67% of the patients with normal LAD, but significant stenosis in the circumflex artery and/or the right coronary artery. Perfusion defects in the circumflex or right coronary artery regions were detected in only 50% of the patients with multiple vessel disease. The authors conclude that stress thallium scintigraphy is a useful diagnostic procedure in patients with chest pain of uncertain origin and identifies the patients to be selected for coronary artery angiography. 15 refs., 2 figs., 2 tabs

The value of myocardial perfusion imaging in differentiating between idiopathic dilated cardiomyopathy from the ischemic form

International Nuclear Information System (INIS)

Fad, A.; Emami, F.; Eftekhari, M.; Saghari, M.; Fallahi, B.; Beiki, D.; Tkavar, A.

2004-01-01

Introduction: differentiating between ischemic cardiomyopathy and idiopathic dilated cardiomyopathy is important as coronary revascularization can improve prognosis in the ischemic subgroup. Due to inherent problems of coronary angiography in patients with depressed ejection fraction introducing a noninvasive tool to diagnose those who will benefit from angiography seems to be rewarding. We examined usefulness of myocardial perfusion scan in this group of patients. Materials and methods: study was performed on 64 patients (62 male and 2 female) aged 57.1 ± 6.7 y (mean ± SD) all with dilation of the left ventricular cavity and ejection fraction less than 40 % by echocardiography. Myocardial perfusion scan was performed in stress and rest phases. All the patients had coronary angiography which was used as the gold standard test. On each set of images, heart was arbitrary divided into 17 segments and perfusion abnormality in each segment was scored by a 5 grade scoring system (0-4). Summed stress Score was used as the scan criteria to differentiate dilated ischemic from idiopathic cardiomyopathy. Scores more than 17 were considered ischemic, and less than that, idiopathic. Results were compared with angiography. Results: from total 40 cases of ischemic cardiomyopathy (proved by angiography) 39 were correctly diagnosed by scan and only one case was mis categorized as idiopathic dilated cardiomyopathy . All 24 cases of idiopathic dilated cardiomyopathy were correctly diagnosed by scintigraphy. Sensitivity, specificity, positive predictive value, and negative predictive value of myocardial perfusion imaging for discrimination between ischemic and idiopathic dilated cardiomyopathy were 97.5 %, 100 %, 100 %, and 96 % respectively. Conclusion: Considering excellent accuracy of myocardial perfusion scan with scoring system in discrimination of ischemic dilated cardiomyopathy from idiopathic cardiomyopathy, this noninvasive test could be considered the main diagnostic test

Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

International Nuclear Information System (INIS)

Jodocy, Daniel; Aglan, Iman; Friedrich, Guy; Mallouhi, Ammar; Pachinger, Otmar; Jaschke, Werner; Feuchtner, Gudrun M.

2010-01-01

Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 ± 6.5 mm; depth, 2.6 ± 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p 50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

Effect of Kaempferol Pretreatment on Myocardial Injury in Rats.

Science.gov (United States)

Vishwakarma, Anamika; Singh, Thakur Uttam; Rungsung, Soya; Kumar, Tarun; Kandasamy, Arunvikram; Parida, Subhashree; Lingaraju, Madhu Cholenahalli; Kumar, Ajay; Kumar, Asok; Kumar, Dinesh

2018-01-20

The present study was undertaken to evaluate the effect of kaempferol in isoprenaline (ISP)-induced myocardial injury in rats. ISP was administered subcutaneously for two subsequent days to induce myocardial injury. Assessment of myocardial injury was done by estimation of hemodynamic functions, myocardial infarcted area, cardiac injury markers, lipid profile, oxidative stress, pro-inflammatory cytokines and histopathology of heart and liver. Rats pretreated with kaempferol showed reduction in the myocardial infarcted area and heart rate. However, no improvement was observed in change in body weight, mean arterial, systolic and diastolic blood pressure. Kaempferol showed significant decrease in serum LDH, CK-MB, troponin-I and lipid profile. However, highest dose of kaempferol did not reduce the serum triglyceride level. Further, antioxidant enzymes, SOD and catalase, were also higher. However, reduced glutathione, serum SGOT and creatinine did not show any improvement. Kaempferol showed reduction in MDA level. Kaempferol at highest dose showed reduction in pro-MMP-2 expression and MMP-9 level. mRNA expression level of TNF-α was not different in kaempferol-pretreated myocardial injured rats with ISP-alone group. Pretreatment with kaempferol at highest dose showed mild mononuclear infiltration and degenerative changes in heart tissue section of myocardial injured rats. Rats pretreated with kaempferol at higher concentration showed normal cordlike arrangement of hepatocytes with moderate swelling of hepatocytes (vacuolar degeneration) around the central vein. Study suggests that kaempferol attenuated lipid profile, infarcted area and oxidative stress in ISP-induced myocardial injury in rats.